Academic Editors: John Lynn Jefferies and Karim Bendjelid
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as
mechanical circulatory support in cardiogenic shock (CS). It restores peripheral
perfusion, at the expense of increased left ventricle (LV) afterload. In this
setting, Impella can be used as direct unloading strategy. Aim of this
meta-analysis was to investigate efficacy and safety of LV unloading with Impella
during ECMO in CS. A systematic search on Medline, Scopus and Cochrane Library
was performed using as combination of keywords: extracorporeal membrane
oxygenation, Impella, percutaneous micro axial pump, ECPELLA, cardiogenic shock.
We aimed to include studies, which compared the use of ECMO with and without
Impella (ECPELLA vs. ECMO). Primary endpoint was short-term all-cause mortality;
secondary endpoints included major bleeding, haemolysis, need for renal
replacement therapy (RRT) and cerebrovascular accident (CVA). Five studies met
the inclusion criteria, with a total population of 972 patients. The ECPELLA
cohort showed improved survival compared to the control group (RR (Risk Ratio):
0.86; 95% CI (Confidence Interval): 0.76, 0.96; p = 0.009). When
including in the analysis only studies with homogeneous comparator groups, LV
unloading with Impella remained associated with significant reduction in
mortality (RR: 0.85; 95% CI: 0.75, 0.97; p = 0.01). Haemolysis (RR:
1.70; 95% CI: 1.35, 2.15; p