Extracorporeal Circulatory Support in Acute Coronary Syndromes

Rita Pavasini, Chiara Cirillo, Gianluca Campo, Miguel Nobre Menezes, Simone Biscaglia, Elisabetta Tonet, Roberto Ferrari, Brijesh V. Patel, Susanna Price
2017 Critical Care Medicine  
Objective: Extracorporeal circulatory support (ECS) is a life-saving technique and its use is increasing in acute coronary syndromes (ACS). A meta-analysis on pooled event rate of short-term mortality and complications of ACS patients treated with ECS was performed. Data sources: Articles were searched in MEDLINE, Cochrane Library, Google Scholar and Biomed Central. Study selection: Inclusion criteria: observational studies on ACS patients treated with ECS. Primary outcome: short-term
more » ... hort-term mortality. Secondary outcomes: ECS-related complications, causes of death, long-term mortality and bridge therapy. Data extraction: Sixteen articles were selected. Data about clinical characteristics, ACS diagnosis and treatment, ECS setting, outcome definitions and event rate were retrieved from the articles. Random-effect meta-analytic pooling was performed reporting results as a summary point estimate and 95% confidence interval. Data synthesis: A total of 739 patients were included (mean age 59.8 ±2.9). The event rate of short-term mortality was 58% (95% CI, 51-64%), 6-month mortality was affecting 24% (95%CI, 5%-63%) of 1-month survivors and 1-year mortality 17% (95%CI, 6%-40%) of 6-month survivors. The event rates of ECS-related complications were: acute renal failure 41%, bleeding 25%, neurologic damage in survivors 21%, sepsis/infections 21% and leg ischemia 12%. Between causes of death, multiorgan failure and brain death affected respectively 40% and 27% of patients. Bridge to ventricular assistance device was offered to 14% of patients and 7% received a transplant. Conclusions: There is still a high rate of short-term mortality and complications in ACS patients treated with ECS. New studies are needed to optimize and standardize ECS. MATERIALS AND METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and recommendations from the Cochrane Collaboration and from the Meta-analysis of Observational Studies in Epidemiology (MOOSE) [24-27]. Search strategy The search strategy was realized with a database search in Pubmed, Cochrane Library, Google Scholar and Biomed Central in May 2016. The search strategy was created by RP. The terms searched were: ((acute coronary syndrome) OR (ACS) OR (myocardial infarction) OR (STEMI) OR (ST elevation myocardial infarction) OR (NSTEMI)) AND (cardiac arrest) AND ((VA ECMO) OR (ECLS) OR (extracorporeal life support) OR (ECPR) OR (extracorporeal CPR) OR (ECMO) OR (extracorporeal membrane oxygenator) OR (mechanical support) OR (portable extracorporeal circulation)). Only papers published in English and in peer-reviewed journals were analyzed. Independent reviewers (RP, CC, MM) analyzed the titles and abstracts of the articles, and determined which of them warranted the examination of the full text. Articles were included if they were: 1) observational studies including only patients with a diagnosis of ACS requiring ECS; 2) presenting data about mortality and/or complications after ECS positioning. Duplicate or animal studies were excluded. All the authors agreed on the final number of studies included. Data extraction, definition, endpoints Independent reviewers (CC, ET, SB) completed the database, which contained information about: the journal; year of publication; authors; baseline characteristics of study population (age, sex, cardiovascular risk factor, past history of cardiovascular or cerebrovascular disease); clinical and instrumental presentation at the time of cardiac arrest; setting of the
doi:10.1097/ccm.0000000000002692 pmid:28841633 fatcat:xyekohgbenb4zly3tbedzom6r4