• Andrea Montisci, Serena Ambrosi, Massimo Baudo, Rosaria Muratore, Giuseppe Cuttone, Nicoletta D'Ettore, and Federico Pappalardo.
• Division of Cardiothoracic Intensive Care, Cardiothoracic Department, ASST Spedali Civili di Brescia, Brescia, Italy. Electronic address: montisci.andrea@yahoo.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Dec 3.

ObjectivesThe benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading.DesignA systematic review and meta-analysis was conducted to examine if there were significant differences in baseline clinical parameters among patients receiving MCS in addition to venoarterial extracorporeal membrane oxygenation (VA ECMO).SettingA total of nine retrospective, three prospective, and two randomized controlled trials were included in this analysis.ParticipantsThe sample sizes ranged from 34 to 1,678 patients.InterventionsThe outcomes were assessments of differences in baseline clinical characteristics and comorbidities among patients that received VA ECMO alone or VA ECMO with intra-aortic balloon pump (IABP) versus ECPella.Measurements And Main ResultsECPella patients showed a higher prevalence of coronary artery disease (65.0% v 34.6%, p < 0.0001), cardiac arrest before MCS implantation (63.1% v 52.7%, p < 0.0001), and ischemic CS (53.1% v 42.6%, p < 0.0001) compared with patients with VA ECMO alone. The comparison between ECPella and VA ECMO + IABP patients showed a higher prevalence of acute myocardial infarction-CS (53.1% v 39.0%, p < 0.0001), preimplantation cardiac arrest (63% v 49.3%, p < 0.0001), and extracorporeal cardiopulmonary resuscitation (25.8% v 20.0%, p = 0.0015). The inclusion of the two randomized controlled trials in the VA ECMO group increased the prevalence of comorbidities compared with the ECPella group.ConclusionsPatients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities.Copyright © 2024. Published by Elsevier Inc.

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