Combined use of intra-aortic balloon pump and impella in cardiogenic shock: A systematic review.

Autor: Farina J; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy. Electronic address: farina.jacopo10@gmail.com., Erriquez A; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy., Campo G; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy., Biscaglia S; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy., Zuin M; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy., Casella G; Cardiology Unit, Ospedale Maggiore, Bologna, Italy., Capecchi A; Cardiology Unit, Ospedale Maggiore, Bologna, Italy., Nobile G; Cardiology Unit, Ospedale Maggiore, Bologna, Italy., Pappalardo F; Cardiothoracic and Vascular Anesthesia and Intensive Care, AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy and AOU Maggiore della Carità, Novara, Italy.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2024 Oct; Vol. 67, pp. 96-102. Date of Electronic Publication: 2024 Apr 25.
DOI: 10.1016/j.carrev.2024.04.296
Abstrakt: Background: Use of Intra-Aortic Balloon Pump (IABP) in combination with Impella has been described as an alternative strategy for mechanical circulatory support (MCS) in patients with cardiogenic shock (CS). We provide a systematic review aimed to explore the effectiveness of this paired MCS approach.
Methods: We conducted a comprehensive systematic search in MEDLINE, Scopus, and Cochrane databases to identify all studies that investigated dual MCS with IABP and Impella.
Results: Our search strategy identified 12 articles, including 1 randomized controlled trial, 1 retrospective study, 1 case series, 7 case report and 2 animal studies. Rationale for this combined MCS strategy stems from an observed reduction in myocardial oxygen demand/supply ratio compared to the use of each device alone, without determining significant variations in left ventricular work. Nonetheless, this combined approach also leads to a 30-40 % decline in Impella flow, increasing the risk of bleeding, Impella displacement, as well as triggering positioning and pressure alarms. Additionally, hemolytic risk data yielded inconclusive results. Importantly, there were no notable disparities in mortality rates when comparing the combined strategy to the use of each device individually.
Conclusion: At the current state-of-the-art, there are no conclusive data demonstrating net clinical benefits of combining Impella with IABP. Considering the substantial risks of morbidity associated, we recommend against its use in clinical practice.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jacopo Farina reports administrative support was provided by University Hospital Arcispedale Sant'Anna of Ferrara Department of Cardiology. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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