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Extracorporeal Circulatory Support in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

Pavasini, Rita MD1; Cirillo, Chiara MD2; Campo, Gianluca MD1; Nobre Menezes, Miguel MD3; Biscaglia, Simone MD1; Tonet, Elisabetta MD1; Ferrari, Roberto MD, PhD1,4; Patel, Brijesh V. MD, PhD5,6; Price, Susanna MD, PhD6

doi: 10.1097/CCM.0000000000002692
Online Review Articles

Objectives: Extracorporeal circulatory support is a life-saving technique, and its use is increasing in acute coronary syndromes. A meta-analysis on pooled event rate of short-term mortality and complications of acute coronary syndrome patients treated with extracorporeal circulatory support was performed.

Data Sources: Articles were searched in MEDLINE, Cochrane Library, Google Scholar, and Biomed Central.

Study Selection: Inclusion criteria were observational studies on acute coronary syndrome patients treated with extracorporeal circulatory support. Primary outcome was short-term mortality. Secondary outcomes were extracorporeal circulatory support–related complications, causes of death, long-term mortality, and bridge therapy.

Data Extraction: Sixteen articles were selected. Data about clinical characteristics, acute coronary syndrome diagnosis and treatment, extracorporeal circulatory support setting, outcome definitions, and event rate were retrieved from the articles. Random effect meta-analytic pooling was performed reporting results as a summary point estimate and 95% CI.

Data Synthesis: A total of 739 patients were included (mean age, 59.8 ± 2.9). The event rate of short-term mortality was 58% (95% CI, 51–64%), 6-month mortality was affecting 24% (95% CI, 5–63%) of 1-month survivors, and 1-year mortality 17% (95% CI, 6–40%) of 6-month survivors. The event rates of extracorporeal circulatory support–related complications were acute renal failure 41%, bleeding 25%, neurologic damage in survivors 21%, sepsis/infections 21%, and leg ischemia 12%. Between causes of death, multiple organ failure and brain death affected respectively 40% and 27% of patients. Bridge to ventricular assistance device was offered to 14% of patients, and 7% received a transplant.

Conclusions: There is still a high rate of short-term mortality and complications in acute coronary syndrome patients treated with extracorporeal circulatory support. New studies are needed to optimize and standardize extracorporeal circulatory support.

1Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy.

2Dipartimento di Scienze Cardiotoraciche, II università degli Studi di Napoli, Neaples, Italy.

3Hospital Universitario de Santa Maria, CHLN, CAML, CCUL, Facultade de Medicina, Universitade de Lisboa, Lisbon, Portugal.

4Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.

5Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom.

6Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom.

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The authors have disclosed that they do not have any potential conflicts of interest.

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