scholarly journals Short term outcomes of Impella in cardiogenic shock: A review and meta-analysis of observational studies

2020 ◽  
Author(s):  
Mario Iannaccone ◽  
Stefano Albani ◽  
Francesco Giannini ◽  
Salvatore Colangelo ◽  
Giacomo G. Boccuzzi ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Observational Studies ◽  
Meta Analysis ◽  
Short Term

scholarly journals Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Shariff ◽  
R Doshi ◽  
I Pedreira Vaz ◽  
D Adalja ◽  
A Krishnan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiogenic Shock ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Shock Trial ◽  
Short Term ◽  
Intra Aortic Balloon Pump ◽  
Short Term Mortality

Abstract Introduction Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock. Purpose A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed. Methods The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence. Results Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP. Conclusion This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock. 30-days Mortality Funding Acknowledgement Type of funding source: None

scholarly journals Correction to: Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

2018 ◽  
Vol 44 (11) ◽  
pp. 2022-2023 ◽  
Author(s):  
Valentine Léopold ◽  
Etienne Gayat ◽  
Romain Pirracchio ◽  
Jindrich Spinar ◽  
Jiri Parenica ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Meta Analysis ◽  
Individual Data ◽  
Short Term ◽  
Term Survival ◽  
Short Term Survival

scholarly journals Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

2020 ◽  
Author(s):  
Judith van Paassen ◽  
Jeroen S. Vos ◽  
Eva M. Hoekstra ◽  
Katinka M.I. Neumann ◽  
Pauline C. Boot ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
Meta Analysis ◽  
Viral Clearance ◽  
Care Group ◽  
Short Term ◽  
Secondary Infections ◽  
Short Term Mortality

Abstract Background: In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In the recent RECOVERY trial, evaluating the effect of dexamethasone, a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroids in COVID-19. However, the effectiveness and safety of corticosteroids still remain uncertain, and reliable data to further shed light on the benefit and harm are needed. Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of corticosteroids in COVID-19. Methods: A systematic literature search of RCTS and observational studies on adult patients was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 1 st of October 2020, according to the PRISMA guidelines. Primary outcomes were short-term mortality and viral clearance (based on RT-PCR in respiratory specimens). Secondary outcomes were: need for mechanical ventilation, other oxygen therapy, length of hospital stay and secondary infections. Results: Forty-four studies were included, covering 20.197 patients. In twenty-two studies, the effect of corticosteroid use on mortality was quantified. The overall pooled estimate (observational studies and RCTs) showed a significant reduced mortality in the corticosteroid group (OR 0.72 (95%CI 0.57-0.87). Furthermore, viral clearance time ranged from 10-29 days in the corticosteroid group and from 8-24 days in the standard of care group. Fourteen studies reported a positive effect of corticosteroids on need for and duration of mechanical ventilation. A trend towards more infections and antibiotic use was present. Conclusions: Our findings from both observational studies and RCTs confirm a beneficial effect of corticosteroids on short-term mortality and a reduction of need for mechanical ventilation. And although data in the studies were too sparse to draw any firm conclusions, there might be a signal of delayed viral clearance and an increase in secondary infections.

scholarly journals Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
Vol 9 (2) ◽  
pp. 414 ◽  
Author(s):  
António Tralhão ◽  
Pedro Póvoa
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
Meta Analysis ◽  
Community Acquired Pneumonia ◽  
Cardiac Complications ◽  
Short Term ◽  
Short Term Mortality ◽  
Coronary Syndromes

Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6–18.9), acute coronary syndromes in 4.5% (95% CI 2.9–6.5), heart failure in 9.2% (95% CI 6.7–12.2), arrhythmias in 7.2% (95% CI 5.6–9.0) and stroke in 0.71% (95% CI 0.1–3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39–5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.

scholarly journals Invited Commentary: The Disillusionment of Developmental Origins of Health and Disease (DOHaD) Epidemiology

2019 ◽  
Vol 189 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen E Gilman ◽  
Mady Hornig
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Developmental Origins ◽  
Short Term ◽  
Hyperactivity Disorder ◽  
Health And Disease ◽  
The Individual ◽  
Meta Analyses

Abstract The developmental origins of health and disease (DOHaD) model promises a greater understanding of early development but has left unresolved the balance of risks and benefits to offspring of medication use during pregnancy. Masarwa et al. (Am J Epidemiol. 2018;187(8):1817–1827) conducted a meta-analysis of the association between in utero acetaminophen exposure and risks of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A challenge of meta-analyzing results from observational studies is that summary measures of risk do not correspond to well-defined interventions when the individual studies adjusted for different covariate sets, which was the case here. This challenge limits the usefulness of observational meta-analyses for inferences about etiology and treatment planning. With that limitation understood, Masarwa et al. reported a 20%–30% higher risk of ADHD and ASD following prenatal acetaminophen exposure. Surprisingly, most of the original studies did not report diagnoses of ADHD or ASD. As a result, their summary estimates of risk are not informative about children’s likelihood of ADHD and ASD diagnoses. The long-term promise of DOHaD remains hopeful, but more effort is needed in the short-term to critically evaluate observational studies suggesting risks associated with medications used to treat conditions during pregnancy that might have adverse consequences for a developing fetus.

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