Journal Article

Intra-aortic balloon pump after VA-ECMO reduces mortality in patients with cardiogenic shock: an analysis of the Chinese extracorporeal life support registry

Du, Zhongtao, Xie, Haixiu, Hao, Xing, Ma, Jiawang, Wang, Liangshan, Hou, Xiaotong, Wang, Hong, Wang, Kexin, Li, Chenglong

2024

Overview

Background The role of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) remains unclear. This study investigated the effect of applying IABP for left ventricle (LV) unloading after VA-ECMO on reducing mortality in patients with CS. Methods Data from 5,492 consecutive patients with CS treated with VA-ECMO between January 2017 and July 2023 were collected from the CSECLS registry. The primary outcome was in-hospital mortality. The secondary outcomes included 30-day mortality, survival on VA-ECMO, and various complications. The association between the application of IABP after VA-ECMO and in-hospital outcomes was assessed. Results Among 5,492 patients undergoing VA-ECMO (mean age 54.7 ± 15.1 years, 3,917 [71.3%] male), 832 (15.1%) received IABP after VA-ECMO. Before VA-ECMO, a higher incidence of cardiac intervention (13.9% vs. 16.7%) and myocardial infarction (12.0% vs. 14.8%) (all P  < 0.05) was seen in the IABP after VA-ECMO group. In this cohort, the IABP after VA-ECMO group had a lower in-hospital mortality (52.5% vs. 48.0%, P  = 0.017) and a higher survival rate on VA-ECMO (75.4% vs. 79.4%, P  = 0.014). On multivariate modeling, the use of IABP after VA-ECMO was associated with a lower risk of in-hospital mortality (adjusted odds ratio[aOR], 0.823 [95% confidence interval [CI], 0.686–0.987]; P  = 0.035) and on-support mortality (aOR, 0.828 [95% CI, 0.688–0.995]; P  = 0.044). However, the use of IABP after VA-ECMO was also associated with an increased incidence of complications, including mechanical (aOR: 1.905, [95% CI, 1.278–2.839]; P  = 0.002), bleeding (aOR: 1.371, [95% CI, 1.092–1.721]; P  = 0.007), renal (aOR: 1.252, [95% CI, 1.041–1.505]; P  = 0.017), and pulmonary (aOR: 1.768, [95% CI, 1.446–2.163]; P  < 0.001). Conclusion In this multicenter retrospective study, the use of IABP after VA-ECMO was associated with lower in-hospital mortality in patients with CS. These findings suggest that IABP may offer advantages for LV unloading in patients with CS treated with VA-ECMO, but further validation through randomized controlled trials is warranted to better understand the balance of risks and benefits.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adult / Aged / Analysis / Body mass index / Cardiogenic shock / Chi-square test / China / China - epidemiology / Complications and side effects / Critical Care Medicine / East Asian People / Emergency Medicine / Extracorporeal membrane oxygenation / Extracorporeal Membrane Oxygenation - methods / Extracorporeal Membrane Oxygenation - mortality / Extracorporeal Membrane Oxygenation - statistics & numerical data / Female / Gender / Heart attacks / Heart failure / Hospital Mortality - trends / Hospitals, Veterans / Humans / Intensive / Intra-Aortic Balloon Pumping - methods / Intra-Aortic Balloon Pumping - statistics & numerical data / Intra-Aortic Balloon Pumping - trends / Intubation / Liver cirrhosis / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Myocarditis / Patient outcomes / Patients / Registries - statistics & numerical data / Regression analysis / Retrospective Studies / Sensitivity analysis / Sepsis / Shock, Cardiogenic - mortality / Shock, Cardiogenic - therapy / Ventilation / Ventilators / Weaning