Unveiling Baseline Clinical Divergence in VA ECMO vs. ECPELLA: Tailoring Treatment for Distinct Patient Profiles. A Systematic Review and Meta-analysis.

Objectives: The benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading.

Design: A systematic review and meta-analysis was conducted to examine if there were significant differences in baseline clinical parameters among patients receiving MCS in addition to venoarterial extracorporeal membrane oxygenation (VA ECMO).

Setting: A total of nine retrospective, three prospective, and two randomized controlled trials were included in this analysis.

Participants: The sample sizes ranged from 34 to 1,678 patients.

Interventions: The outcomes were assessments of differences in baseline clinical characteristics and comorbidities among patients that received VA ECMO alone or VA ECMO with intra-aortic balloon pump (IABP) versus ECPella.

Measurements And Main Results: ECPella patients showed a higher prevalence of coronary artery disease (65.0% v 34.6%, p < 0.0001), cardiac arrest before MCS implantation (63.1% v 52.7%, p < 0.0001), and ischemic CS (53.1% v 42.6%, p < 0.0001) compared with patients with VA ECMO alone. The comparison between ECPella and VA ECMO + IABP patients showed a higher prevalence of acute myocardial infarction-CS (53.1% v 39.0%, p < 0.0001), preimplantation cardiac arrest (63% v 49.3%, p < 0.0001), and extracorporeal cardiopulmonary resuscitation (25.8% v 20.0%, p = 0.0015). The inclusion of the two randomized controlled trials in the VA ECMO group increased the prevalence of comorbidities compared with the ECPella group.

Conclusions: Patients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities.