POOLED FREQUENCY OF STROKE WITHIN 30-DAYS FOLLOWING MECHANICAL CIRCULATORY SUPPORT WITH IMPELLA 5.0®/LD® DEVICE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF STUDIES PUBLISHED IN THE LAST DECADE (2009-2019)

ObjectiveThe survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting.DesignSystematic review and meta-analysis.Data sourcesEmbase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021.Eligibility criteriaRandomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included.Data extraction and synthesisData were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model.ResultsTwelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I2=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I2=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I2=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I2=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I2=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I2=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%).ConclusionsIn all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not.

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Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis

Critical Care ◽

10.1186/s13054-021-03668-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Ryan Ruiyang Ling ◽

Kollengode Ramanathan ◽

Wynne Hsing Poon ◽

Chuen Seng Tan ◽

Nicolas Brechot ◽

...

Keyword(s):

Septic Shock ◽

Extracorporeal Membrane Oxygenation ◽

Mechanical Circulatory Support ◽

Meta Analysis ◽

Left Ventricular ◽

Adult Patients ◽

Circulatory Support ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Septic Shock ◽

Va Ecmo

Abstract Background While recommended by international societal guidelines in the paediatric population, the use of venoarterial extracorporeal membrane oxygenation (VA ECMO) as mechanical circulatory support for refractory septic shock in adults is controversial. We aimed to characterise the outcomes of adults with septic shock requiring VA ECMO, and identify factors associated with survival. Methods We searched Pubmed, Embase, Scopus and Cochrane databases from inception until 1st June 2021, and included all relevant publications reporting on > 5 adult patients requiring VA ECMO for septic shock. Study quality and certainty in evidence were assessed using the appropriate Joanna Briggs Institute checklist, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, respectively. The primary outcome was survival to hospital discharge, and secondary outcomes included intensive care unit length of stay, duration of ECMO support, complications while on ECMO, and sources of sepsis. Random-effects meta-analysis (DerSimonian and Laird) were conducted. Data synthesis We included 14 observational studies with 468 patients in the meta-analysis. Pooled survival was 36.4% (95% confidence interval [CI]: 23.6%–50.1%). Survival among patients with left ventricular ejection fraction (LVEF) < 20% (62.0%, 95%-CI: 51.6%–72.0%) was significantly higher than those with LVEF > 35% (32.1%, 95%-CI: 8.69%–60.7%, p = 0.05). Survival reported in studies from Asia (19.5%, 95%-CI: 13.0%–26.8%) was notably lower than those from Europe (61.0%, 95%-CI: 48.4%–73.0%) and North America (45.5%, 95%-CI: 16.7%–75.8%). GRADE assessment indicated high certainty of evidence for pooled survival. Conclusions When treated with VA ECMO, the majority of patients with septic shock and severe sepsis-induced myocardial depression survive. However, VA ECMO has poor outcomes in adults with septic shock without severe left ventricular depression. VA ECMO may be a viable treatment option in carefully selected adult patients with refractory septic shock.

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A systematic review of psychosocial design considerations for the next generation of mechanical circulatory support

Heart & Lung ◽

10.1016/j.hrtlng.2021.01.021 ◽

2021 ◽

Vol 50 (3) ◽

pp. 397-406

Author(s):

Dr. Sean Peel ◽

Kimmi Keum Hee Ko ◽

Dr. Erez Nusem ◽

Dr. Karla Straker ◽

Professor Cara Wrigley

Keyword(s):

Systematic Review ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Next Generation ◽

Design Considerations

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Mechanical Circulatory Support in Cardiogenic Shock Following an Acute Myocardial Infarction: A Systematic Review

Journal of Cardiac Surgery ◽

10.1111/jocs.12405 ◽

2014 ◽

Vol 29 (5) ◽

pp. 743-751 ◽

Cited By ~ 5

Author(s):

Manuel Caceres ◽

Fardad Esmailian ◽

Jaime D. Moriguchi ◽

Francisco A. Arabia ◽

Lawrence S. Czer

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Circulatory Support

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TCT-819 Safety and Efficacy of Mechanical Circulatory Support With Impella or Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention and/or Cardiogenic Shock: Insights From a Network Meta-Analysis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.965 ◽

2019 ◽

Vol 74 (13) ◽

pp. B802

Author(s):

Toshiki Kuno ◽

Hisato Takagi ◽

Tomo Ando ◽

Satoshi Miyashita ◽

Masaki Kodaira ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

High Risk ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Meta Analysis ◽

Coronary Intervention ◽

Circulatory Support ◽

Safety And Efficacy ◽

Intra Aortic Balloon Pump ◽

Percutaneous Coronary

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Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx088 ◽

2017 ◽

Vol 52 (1) ◽

pp. 14-25 ◽

Cited By ~ 50

Author(s):

Corstiaan A. den Uil ◽

Sakir Akin ◽

Lucia S. Jewbali ◽

Dinis dos Reis Miranda ◽

Jasper J. Brugts ◽

...

Keyword(s):

Mechanical Circulatory Support ◽

Meta Analysis ◽

Left Ventricular ◽

Circulatory Support ◽

Short Term ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Refractory Cardiogenic Shock ◽

Left Ventricular Assist

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The Effect of Different Types of Mechanical Circulatory Support on Mortality of Patients after Adult Cardiac Surgery: A Systematic Review and Meta-Analysis

The Heart Surgery Forum ◽

10.1532/hsf.2979 ◽

2020 ◽

Vol 23 (4) ◽

pp. E537-E545

Author(s):

Zhiyuan Guan ◽

Xiaoqing Guan ◽

Kaiyun Gu ◽

Yanqi Li ◽

Jin Lin ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Mechanical Circulatory Support ◽

Web Of Science ◽

Meta Analysis ◽

Circulatory Support ◽

Pooled Data ◽

Different Types ◽

Postcardiotomy Shock ◽

Adult Cardiac Surgery

Objectives: Sample size may limit the ability of individual studies to detect differences in clinical outcomes between extracorporeal membrane oxygenation (ECMO) alone and ECMO plus intra-aortic balloon pump (IABP) after adult cardiac surgery. Therefore, we undertook a meta-analysis of the best evidence available on the comparison of clinical outcomes of ECMO alone and ECMO plus IABP after adult cardiac surgery. Methods: PubMed, EMBASE, Web of Science, and Cochrane Center Registry of Controlled Trials were searched for studies comparing the use of ECMO alone and ECMO plus IABP after adult cardiac surgery. A meta-analysis and a sensitivity analysis were conducted. Results: Among the 472 screened articles, 24 studies (1302 cases of ECMO plus IABP and 1603 cases of ECMO) were included. A significant relationship between patient risk profile and benefits from IABP plus ECMO was found in terms of the 30-day mortality (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.62 to 0.91; P = .004) with postcardiotomy shock (PCS). However, ECMO alone was associated with lower in-hospital mortality (OR 1.75; 95% CI 1.06 to 3.01; Z = 2.19; P = .03) compared with ECMO plus IABP without PCS. Conclusions: Pooled data show that patients receiving IABP plus ECMO with PCS have lower 30-day mortality than those receiving ECMO also, which in turn show higher 30-day mortality in patients with IABP plus ECMO without PCS. Further randomized studies are warranted to corroborate these observational data.

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Antibiotic regimens for neonatal sepsis - a protocol for a systematic review with meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1207-1 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Steven Kwasi Korang ◽

Sanam Safi ◽

Christian Gluud ◽

Ulrik Lausten-Thomsen ◽

Janus C. Jakobsen

Keyword(s):

Systematic Review ◽

Health Care Professionals ◽

Neonatal Sepsis ◽

Sequential Analysis ◽

Meta Analysis ◽

Cochrane Library ◽

Circulatory Support ◽

Trial Sequential Analysis ◽

Clinical Effects ◽

Neonates And Infants

Abstract Background Sepsis is a major cause of morbidity and mortality among neonates and infants. Antibiotics are a central part of the first line treatment for sepsis in neonatal intensive care units worldwide. However, the evidence on the clinical effects of the commonly used antibiotic regimens for sepsis in neonates remains scarce. This systematic review aims to assess the efficacy and harms of antibiotic regimens for neonatal sepsis. Methods Electronic searches will be conducted in MEDLINE, Embase, The Cochrane Library, CINAHL, ZETOC and clinical trial registries (clinicaltrials.gov and ISRCTN). We will include randomised controlled trials of different antibiotic regimens for sepsis of neonates and infants. Eligible interventions will be any antibiotic regimen. Two reviewers will independently screen, select, and extract data. The methodological quality of individual studies will be appraised following Cochrane methodology. Primary outcomes will be ‘all-cause mortality’ and ‘serious adverse events’. Secondary outcomes will be ‘need for respiratory support’, ‘need for circulatory support’, ‘neurodevelopmental impairment’, ototoxicity, nephrotoxicity and necrotizing enterocolitis. We plan to perform a meta-analysis with trial sequential analysis. Discussion This is the study protocol for a systematic review on the effects of different antibiotic regimens for neonatal sepsis. The results of this systematic review intent to adequately inform stakeholders or health care professionals in the field of neonatal sepsis, and to aid appropriate development of treatment guidelines. Systematic review registration PROSPERO reference number: CRD42019134300.

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