Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta–Analysis

Sohail S., Fan E., Foroutan F., Ross H. J., Billia F., Alba A. C.

Journal of Cardiovascular Translational Research, vol.15, no.2, pp.227-238, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 15 Issue: 2
  • Publication Date: 2022
  • Doi Number: 10.1007/s12265-021-10140-w
  • Journal Name: Journal of Cardiovascular Translational Research
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
  • Page Numbers: pp.227-238
  • Keywords: VA-ECMO, Cardiogenic shock, Myocardial infarction, Mortality
  • TED University Affiliated: No

Abstract

© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.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.