Early Versus Bail-Out Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review And Meta-Analysis
Department
Internal Medicine
Additional Department
Cardiology
Document Type
Article
Publication Title
Journal of Cardiothoracic and Vascular Anesthesia
Abstract
Left ventricular (LV) unloading has demonstrated favorable outcomes in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the optimal timing for LV unloading during VA-ECMO remains controversial. PubMed, Embase, and Cochrane were searched for studies comparing early versus bail-out LV unloading in patients undergoing VA-ECMO. We computed mean differences (MD) for continuous outcomes and risk ratios (RR) for binary outcomes, with 95% confidence intervals (95%CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R version 4.2.3. Six studies comprising 1,556 participants were included in the meta-analysis, of whom 936 (60%) were referred to early LV unloading. There were no significant differences between groups in weaning from VA-ECMO (MD 1.07; 95% CI 0.86 - 1.33; p = 0.55; I² = 26%), in-hospital mortality (RR 0.95; 95% CI 0.86 - 1.05; p = 0.28; I² = 0%), 30-day mortality (RR 0.75; 95% CI 0.52 - 1.10; p = 0.14; I² = 64%), or duration of VA-ECMO (MD 0.37; 95% CI -1.57 - 2.32; p = 0.71; I² = 20%). Sepsis (RR 0.84; 95% CI 0.63 - 1.11; p = 0.22; I² = 0%), stroke (RR 0.90; 95% CI 0.52 - 1.56; p = 0.70; I² = 48%), and bridge to heart transplantation or left ventricular assist device (RR 1.20; 95% CI 0.90 - 1.62; p = 0.22; I² = 0%) also did not differ significantly between the groups. In patients undergoing VA-ECMO, early LV unloading was not associated with improved efficacy and safety outcomes when compared to the bail-out strategy for LV unloading.
First Page
1015
Last Page
1025
DOI
10.1053/j.jvca.2025.01.005
Volume
39
Issue
4
Publication Date
4-1-2025
Medical Subject Headings
Extracorporeal Membrane Oxygenation (methods); Humans; Heart-Assist Devices; Hospital Mortality; Ventricular Function, Left (physiology)
PubMed ID
39934065
Recommended Citation
Picado-Loaiza, S., Ayala, R., Ferreira, R. O., Zeledón, F., Almeidinha, L., Clemente, M., Bittar de Pontes, V., & Lee, E. C. (2025). Early Versus Bail-Out Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review And Meta-Analysis. Journal of Cardiothoracic and Vascular Anesthesia, 39 (4), 1015-1025. https://doi.org/10.1053/j.jvca.2025.01.005
