Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

BACKGROUND: Left ventricular decompression is the primary method for solving VA-ECMO-induced LV afterload increase, but the effect of specific methods on patient outcomes and complications is unknown. MATERIAL/METHODS: We searched for all published reports conducted in patients undergoing ECMO combined with LVD. Statistical analyses were performed using Stata 12.0. RESULTS: The results showed that the risk of death with ECMO combined with LVD was 29% lower than that with ECMO alone (OR=0.71, 95% CI: 0.56–0.89, I(2)=59.5%, P<0.001). Although the risk of death with ECMO combined other LV decompression techniques was higher than that with ECMO combined with IABP, the difference was not statistically significant (OR=1.27, 95% CI: 0.86–1.87, I(2)=44.0%, P=0.057). In addition, the ORs values of hemorrhage, stroke/acute episodes, lower-limb ischemia, and hemolysis for ECMO combined with LVD were 0.69 (0.66–0.71), 0.82 (0.78–0.89), 0.71 (0.30–1.66), and 0.48 (0.16–1.39), respectively. The risk of complications, such as stroke/TIA, limb ischemia, and hemolysis, of ECMO combined with IABP was lower than that of ECMO combined other LV decompression techniques, and the risk of bleeding was higher for ECMO combined with IABP. CONCLUSIONS: ECMO combined with LVD is more beneficial than using ECMO alone and helps to lower patient mortality.