Early Versus Bail-Out Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review And Meta-Analysis
Authors' conclusion
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.
Study context
- Population
- Patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO)
- Participants
- 1,556 patients · 6 studies
- Comparison
- Early vs bail-out left ventricular (LV) unloading during VA-ECMO
- Earlyn = 936
- Outcome
- Weaning from VA-ECMO, in-hospital mortality, 30-day mortality, duration of VA-ECMO (early vs bail-out LV unloading)
Pooled result
As reported in the abstract
Weaning from VA-ECMO: no significant difference between groups
MD 1.07; 95% CI 0.86 - 1.33; p = 0.55; I² = 26%
In-hospital mortality: no significant difference between groups
RR 0.95; 95% CI 0.86 - 1.05; p = 0.28; I² = 0%
30-day mortality: no significant difference between groups
RR 0.75; 95% CI 0.52 - 1.10; p = 0.14; I² = 64%
Duration of VA-ECMO: no significant difference between groups
MD 0.37; 95% CI −1.57 - 2.32; p = 0.71; I² = 20%
Further pooled results
Bridge to heart transplantation or LV assist device (early vs bail-out LV unloading)
- Bridge to heart transplantation or LV assist device: no significant difference between groups
- RR 1.20; 95% CI 0.90 - 1.62; p = 0.22; I² = 0%
Safety
Sepsis (early vs bail-out LV unloading)
- Sepsis: no significant difference between groups
- RR 0.84; 95% CI 0.63 - 1.11; p = 0.22; I² = 0%
Stroke (early vs bail-out LV unloading)
- Stroke: no significant difference between groups
- RR 0.90; 95% CI 0.52 - 1.56; p = 0.70; I² = 48%
Original publication
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