Shahmir Sohail1,2,3, Eddy Fan4,5, Farid Foroutan6,7,4, Heather J Ross6,7,4, Filio Billia6,7,4, Ana Carolina Alba6,7,4. 1. Division of Cardiology, Peter Munk Cardiac Center, University of Toronto, Toronto, ON, Canada. shahmir.sohail@mail.utoronto.ca. 2. Ted Rogers Centre for Heart Research, University of Toronto, Toronto, ON, Canada. shahmir.sohail@mail.utoronto.ca. 3. Toronto General Hospital, Toronto, ON, Canada. shahmir.sohail@mail.utoronto.ca. 4. Toronto General Hospital, Toronto, ON, Canada. 5. Interdisciplinary Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 6. Division of Cardiology, Peter Munk Cardiac Center, University of Toronto, Toronto, ON, Canada. 7. Ted Rogers Centre for Heart Research, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI. METHODS: We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009. RESULTS: 72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality. CONCLUSION: These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.
BACKGROUND: Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI. METHODS: We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009. RESULTS: 72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality. CONCLUSION: These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.
Authors: Ryan P Barbaro; Folafoluwa O Odetola; Kelley M Kidwell; Matthew L Paden; Robert H Bartlett; Matthew M Davis; Gail M Annich Journal: Am J Respir Crit Care Med Date: 2015-04-15 Impact factor: 21.405
Authors: Hyoung Soo Kim; Kyu Jin Lee; Sang Ook Ha; Sang Jin Han; Kyoung-Ha Park; Sun Hee Lee; Yong Il Hwang; Seung Hun Jang; Sunghoon Park Journal: Medicine (Baltimore) Date: 2020-07-17 Impact factor: 1.817