Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F23%3A00009706" target="_blank" >RIV/00023884:_____/23:00009706 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11130/23:10467131 RIV/00216208:11110/23:10467131 RIV/00216208:11140/23:10467131 RIV/00669806:_____/23:10467131 and 2 more

Result on the web

<a href="https://www-sciencedirect-com.ezproxy.lib.cas.cz/science/article/pii/S0140673623016070?via%3Dihub" target="_blank" >https://www-sciencedirect-com.ezproxy.lib.cas.cz/science/article/pii/S0140673623016070?via%3Dihub</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/S0140-6736(23)01607-0" target="_blank" >10.1016/S0140-6736(23)01607-0</a>

Result language

angličtina

Original language name

Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials

Original language description

Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. Methods Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). Findings Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0 center dot 93; 95% CI 0 center dot 66-1 center dot 29). Complication rates were higher with VA-ECMO for major bleeding (OR 2 center dot 44; 95% CI 1 center dot 55-3 center dot 84) and peripheral ischaemic vascular complications (OR 3 center dot 53; 95% CI 1 center dot 70-7 center dot 34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction >= 0 center dot 079). Interpretation VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30218 - General and internal medicine

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2023

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Lancet

ISSN

0140-6736

e-ISSN

—

Volume of the periodical

402

Issue of the periodical within the volume

10410

Country of publishing house

US - UNITED STATES

Number of pages

9

Pages from-to

1338-1346

UT code for WoS article

001100992400001

EID of the result in the Scopus database

2-s2.0-85170103815