Hematological Complications of Impella as an Unloading Device in Patients with Cardiogenic Shock and Veno-Arterial ECMO. A Systematic Review and Metanalysis

Abstract

Purpose Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly used in patients with severe cardiogenic shock. However, left ventricular unloading may be impaired due to an increase in afterload caused by VA-ECMO. Impella has surged as an unloading device in this scenario but, its concomitant use with VA-ECMO has been associated with a higher risk of bleeding, hemolysis and acute kidney injury (AKI) requiring renal replacement therapy (RRT) in these patients. Methods This is a metanalysis and systematic review that aimed to evaluate the hematological complications of the concomitant use of Impella and VA-ECMO in patients with cardiogenic shock. Pubmed, Cochrane and Scopus data based were used. Primary end-point included hemolysis, bleeding, and AKI requiring RRT. Results Three studies met the inclusion criteria. The use of Impella as an unloading device in patients with cardiogenic shock on VA-ECMO was associated with increasing the risk of hemolysis RR: 2.64, 95% CI (1.97-3.55) p= Conclusion This metanalysis suggests that the use of Impella as an unloading device in patients with cardiogenic shock in VA-ECMO has a higher risk of hemolysis, but an equal risk of bleeding and AKI requiring RRT than patients treated with VA-ECMO alone.