Patients in refractory cardiogenic shock may benefit from the use of venoarterial extracorporeal membrane oxygenation (va-ECMO). In patients at high risk of mortality, this temporary support bridges the gap until recovery, permanent assist, or transplantation. Despite the ongoing advances in critical care medicine, severe cardiogenic shock is still associated with a high mortality rate, and the usefulness of this approach is still up for debate. In light of this, the purpose of this study was to conduct a literature review on va-ECMO for cardiogenic shock patients, focusing on in-hospital mortality and complications. To evaluate the results of va-ECMO assistance, researchers performed a systematic review and meta-analysis of the current research. Medline (PubMed) and Scopus (Elsevier) databases were systematically searched up to May 2022 using the PRISMA criteria. Publication-level factors were pooled using a meta-analysis with a weighted random effects model to account for the overall number of studies included in the meta-analysis. In total, 32 studies with a total of 12,756 patients were included in this review. The percentage of hospital-related deaths was 62% (1994-2019, pooled estimate: 8,493/12,756). During the time that they were being supported by ECMO, more than 1/3rd of patients passed away. Renal failure (51%, 693/1,351), requiring renal replacement therapy (44%, 4,879/11,186), and bleeding (49%, 1,971/4,523) were the most common consequences, each with the potential to cause lifelong harm or death. Over 60 years of age, shorter ECMO duration, and the presence of infection were all related to in-hospital mortality in univariate meta-regression analysis, while studies reporting a greater incidence of cannulation site bleeding were unexpectedly associated with reduced in-hospital mortality. The use of extracorporeal membrane oxygenation is a form of invasive life support that comes with a significant potential for problems. Investigators found that older patients, those with infections, and those on ECMO for longer periods at 62% higher risk of dying in the hospital overall. The frequency of unintended consequences needs to be mitigated. Hence new protocols and methods are needed. Lastly, randomized trials need to prove va-efficacy ECMO in cardiogenic shock.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-022-01067-9
