Comparison of ECMO vs ECpella in Patients With Non-Post-Pericardiotomy Cardiogenic Shock: An Updated Meta-Analysis

• Published in: Cardiovascular revascularization medicine 2022-07, Vol.40, p.134-141
• Main Authors: Iannaccone, Mario, Venuti, Giuseppe, di Simone, Emanuela, De Filippo, Ovidio, Bertaina, Maurizio, Colangelo, Salvatore, Boccuzzi, Giacomo, de Piero, Maria Elena, Attisani, Matteo, Barbero, Umberto, Zanini, Paola, Livigni, Sergio, Noussan, Patrizia, D'Ascenzo, Fabrizio, de Ferrari, Gaetano Maria, Porto, Italo, Truesdell, Alexander G.
• Format: Article
• Language: English
• Subjects: Cardiogenic shock; ECMO; ECpella; Mechanical support
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2021.10.001

The impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS. All studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes. Of 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6–59.9) in the VA-ECMO group and 58.3% (53.5–63.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9–26.5) and 33.1% (25.9–41.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0–22.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039–3.159). Our data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates. •30-Day mortality of non post-pericardiotomy CS remains high despite the use of MCS.•ECpella may have some protective effect on CS patients. However, major bleeds are more frequent in patients treated with ECpella than ECMO.•Patients treated with ECpella had lower rates of HT or LVAD, suggesting that this strategy may be linked to an increased heart recovery compered to ECMO.