Table 4.
Active intra-aortic venting
| Venting mode | Authors | Year | Trial Type | Trial demograhics | VA-ECMO-Indication | Venting Technique | Timing of venting initiation | |
|---|---|---|---|---|---|---|---|---|
| Active, aorta, (percutaneous) | IABP | Meani et al. [10] | 2019 | Singlecenter, retrospective (Enrollment period 2007–2018) | n = 10, mean age: 60 years, 80% male | AMI: 20%; PCS: 30%; myocarditis: 10%; ARVC: 10%; type A dissection: 10%; papillary muscle rupture: 10%; endocarditis: 10% | Percutaneous insertion of IABP | No information |
| Tepper et al. [70] | 2019 | Singlecenter, retrospective (Enrollment period 2010–2016) | n = 60, mean age: 50.5 years (VA-ECMO alone group), 57.2 years (VA-ECMO + IABP group) (p = 0.08), 47% (VA-ECMO alone), 60% (VA-ECMO + IABP) male | AMI: 7% (VA-ECMO alone), 7% (VA-ECMO + IABP); myocarditis: 3% (VA-ECMO alone), 3% (VA-ECMO + IABP); ischemic cardiomyopathy: 10% (VA-ECMO alone), 3% (VA-ECMO + IABP); non-ischemic cardiomyopathy: 13% (VA-ECMO alone), 7% (VA-ECMO + IABP); PCS: 47% (VA-ECMO alone), 67% (VA-ECMO + IABP); post-transplant graft dysfunction: 10% (VA-ECMO alone), 10% (VA-ECMO + IABP); other: 10% (VA-ECMO alone), 3% (VA-ECMO + IABP) | Percutaneous insertion of IABP | No information | ||
| Brechot et al. [69] | 2018 | Singlecenter, retrospective (Enrollment period 2007–2012) | n = 259, rate of decompression using IABP in total study population: 40.2%, 1:1 propensity matched analysis of n = 63 undergoing VA-ECMO + IABP compared to n = 63 VA-ECMO alone | AMI: 65.1% (VA-ECMO alone), 62% (VA-ECMO + IABP); myocarditis: 9.5% (VA-ECMO alone), 9.5% (VA-ECMO + IABP); dilated cardiomyopathy: 19.0% (VA-ECMO alone), 23.8% (VA-ECMO + IABP); other: 6.3% (VA-ECMO alone), 4.8% (VA-ECMO + IABP); pre-VA-ECMO cardiac arrest: 50.8% (VA-ECMO alone), 44.4% (VA-ECMO + IABP) [matched cohort] | Percutaneous insertion of a 40 ml IABP (Maquet) | No information | ||
| Lin et al. [71] | 2016 | Singlecenter, retrospective (Enrollment period 2002–2013) | n = 529, rate of decompression using IABP in total study population: 57% (mean age: 52.8 years (VA-ECMO alone group), 56.8 years (IABP group) (p = 0.004), 70% (VA-ECMO alone), 79.5% (IABP) male (p = 0.014)), considerable differences in baseline criteria (BMI, hypertension, diabetes mellitus, smoking status) | AMI: 25.6% (VA-ECMO alone), 58.9% (IABP); cardiomyopathy: 27.3% (VA-ECMO alone), 17.2% (IABP); PCS: 31.7% (VA-ECMO alone), 12.9% (IABP); myocarditis: 15.4% (VA-ECMO alone), 10.9% (IABP) (p < 0.001) | Percutaneous insertion of IABP | IABP initiation within 24 h after VA-ECMO initiation | ||
| Aso et al. [68] | 2016 | Multicenter, retrospective (Enrollment period 2010–2013) | n = 1,650, rate of decompression using IABP in total study population: 36%, 1:1 propensity matched analysis of n = 533 undergoing VA-ECMO + IABP compared to n = 533 VA-ECMO alone | AMI: 40.7% (VA-ECMO alone), 39.2% (VA-ECMO + IABP); heart failure: 38.1% (VA-ECMO alone), 40.5% (VA-ECMO + IABP); myocarditis: 9.0% (VA-ECMO alone), 9.0% (VA-ECMO + IABP); valvular disease: 9.0% (VA-ECMO alone), 7.9% (VA-ECMO + IABP); cardiomyopathy: 1.9% (VA-ECMO alone), 2.4% (VA-ECMO + IABP); takostubo cardiomyopathy: 1.1% (VA-ECMO alone), 0.8% (VA-ECMO + IABP); infectious endocarditis: 0.2% (VA-ECMO alone), 0.2% (VA-ECMO + IABP) [matched cohort] | Percutaneous insertion of IABP | No information | ||
| Gass et al. [72] | 2014 | Multicenter, retrospective (Enrollment period 2007–2012) | n = 137, mean age: 57.3 years, 64.4% male | Cardiogenic shock: 66.7%; PCS: 17.8%; pulmonary embolism: 4.4%; respiratory failure: 7.4%; right heart failure after LVAD: 3.7% | Percutaneous insertion of IABP | IABP initiation prior to VA-ECMO initiation: 41% | ||
| Petroni et al. [73] | 2014 | Singlecenter, prospective (Enrollment period 2010–2011) | n = 12, mean age: 57 years, 75% male | AMI: 67%; myocarditis: 8%; valvular dysfunction: 17%; dilated cardiomyopathy: 8% | Percutaneous insertion of IABP (Maquet) | Mean interval from VA-ECMO initiation to hemodynamic test: 6.3 days; mean interval from IABP initiation to hemodynamic test: 4.7 days | ||
| Venting mode | Mechanical support duration | Follow-up time | Hemodynamic effect of decompression | Mortality outcome | Additional outcome information | Complications/adverse events | |
|---|---|---|---|---|---|---|---|
| Active, aorta, (percutaneous) | IABP | Mean duration of VA-ECMO: 8 days | No infor-mation | Aortic valve re-opening after IABP placement: 80% | In-hospital mortality rate: 80% | VA-ECMO weaning rate: 10%; bridge to heart transplantation: n = 1; in n = 3 further LV decompression was required using a PA venting cannula | No information |
| No information | 30 days | CVP: 16 mmHg (VA-ECMO alone, at ECMO initiation), 13 mmHg (VA-ECMO alone, 48 h after ECMO initiation) (p = 0.16), 15 mmHg (VA-ECMO + IABP, at ECMO initiation), 12 mmHg (VA-ECMO + IABP, 48 h after ECMO initiation) (p = 0.01) | 30-day mortality rate: 67% (VA-ECMO alone), 50% (VA-ECMO + IABP) (p = 0.06) | VA-ECMO decannulation rate: 53% (VA-ECMO alone), 67% (VA-ECMO + IABP); bridge to durable LVAD: 20% (VA-ECMO alone), 13% (VA-ECMO + IABP) | Bleeding: 27% (VA-ECMO alone), 30% (VA-ECMO + IABP) (p = 0.77); limb ischemia: 3% (VA-ECMO alone), 7% (VA-ECMO + IABP) (p = 1); ischemic stroke: 10% (VA-ECMO alone), 17% (VA-ECMO + IABP) (p = 0.71) | ||
| Median duration of VA-ECMO: 3 days (VA-ECMO alone), 4 days (VA-ECMO + IABP); median duration of IABP: 4 days [matched cohort] | No infor-mation | Fewer radiographical signs of pulmonary edema assessed by Weinberg score in VA-ECMO + IABP group compared to VA-ECMO alone (p < 0.0001) [matched cohort] | ICU mortality rate: 55.5% (VA-ECMO alone), 44.4% (VA-ECMO + IABP); OR for ICU mortality with IABP: 0.54 (p = 0.06) [matched cohort] | Days off mechanical ventilation during VA-ECMO: 0.6 days (VA-ECMO alone), 2.0 days (VA-ECMO + IABP) (p = 0.005) [matched cohort] | IABP-related complications: minor hemorrhage at insertion site: 14%; minor distal ischemia: 5%, device dysfunction: 3%; infection at insertion site: 1% [matched cohort] | ||
| Mean duration of VA-ECMO: 4.0 days (VA-ECMO alone), 4.0 days (IABP); mean duration of IABP: 5.0 days | 14 days | Systolic BP: 99.5 mmHg (VA-ECMO alone), 107.6 mmHg (IABP) (p < 0.001); diastolic BP: 65.1 mmHg (VA-ECMO alone), 57.4 mmHg (IABP) (p < 0.001); CVP: 12.3 mmHg (VA-ECMO alone), 11.6 mmHg (IABP) (p = 0.08); lactate: 3.0 mmol/L (VA-ECMO alone), 3.1 mmol/L (IABP) (p = 0.588) | 14-day mortality rate: 48.5% (VA-ECMO alone), 47.7% (IABP) (p = 0.861) | Bridge to durable LVAD: 0.9% (VA-ECMO alone), 0% (IABP) (p = 0.184); bridge to heart transplantation: 7.5% (VA-ECMO alone), 4.0% (IABP) (p = 0.085) | Vascular complications requiring reperfusion: 47.1% (VA-ECMO alone), 49.3% (IABP) (p = 0.660); limb fasciotomy operation due to vascular complications: 0% (VA-ECMO alone), 2.6% (IABP) (p = 0.012); digital gangrene: 9.7% (VA-ECMO alone), 7.6% (IABP) (p = 0.433) | ||
| No information | No infor-mation | No information | 28-day mortality rate: 58.2% (VA-ECMO alone), 48.4% (VA-ECMO + IABP) (p = 0.001); in-hospital mortality rate: 64.5% (VA-ECMO alone), 55.9% (VA-ECMO + IABP) (p = 0.004); 28-day mortality rate without continuous renal replacement therapy: 56.1% (VA-ECMO alone), 42.6% (VA-ECMO + IABP) (p < 0.001); in-hospital mortality rate without continuous renal replacement therapy: 61.6% (VA-ECMO alone), 50.3% (VA-ECMO + IABP) (p = 0.001) [matched cohort] | Weaning rate: 73.4% (VA-ECMO alone), 82.6% (VA-ECMO + IABP) (p < 0.001) [matched cohort] | No information | ||
| Mean duration of VA-ECMO: 8.5 days | No infor-mation | No information | In-hospital mortality rate: 32.1% (IABP first), 49.4% (VA-ECMO first) (p = 0.053) | Bridge to durable LVAD: 14.8%; bridge to heart transplantation: 3%; prior IABP initiation independently associated with lower risk of composite mortality, stroke or vascular complication requiring intervention: OR 0.353 (p = 0.031) | Access-site bleeding: 23.2% (IABP first), 7.6% (VA-ECMO first) (p = 0.013); sepsis: 7.1% (IABP first), 15.2% (VA-ECMO first) (p = 0.185); prolonged ventilation: 64.3% (IABP first), 43% (VA-ECMO first) (p = 0.023); stroke: 10.7% (IABP first), 11.4% (VA-ECMO first) (p = 1.0); gastrointestinal bleeding: 16.1% (IABP first), 15.2% (VA-ECMO first) (p = 1.0); limb ischemia: 8.9% (IABP first), 10.1% (VA-ECMO first) (p = 1.0); vascular complication requiring intervention: 14.3% (IABP first), 17.7% (VA-ECMO first) (p = 0.644) | ||
| No information | No infor-mation | LVEDD: 55 mm (IABP off), 47 mm (IABP restart) (p = 0.003); mean PAP: 24 mmHg (IABP off), 19 mmHg (IABP restart) (p = 0.02); systolic PAP: 29 mmHg (IABP off), 23 mmHg (IABP restart) (p = 0.01); PCWP: 19 mmHg (IABP off), 15 mmHg (IABP restart) (p = 0.01) | Mortality rate: 50% | Myocardial recovery: 25%; bridge to durable LVAD: 17%; bridge to artificial heart: 8% | Renal replacement therapy: 42% | ||
VA-ECMO, venoarterial extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; BMI, body mass index; AMI, acute myocardial infarction; PCS, postcardiotomy shock; ARVC, arrhythmogenic right ventricular cardiomyopathy; PA, pulmonary artery; LV, left ventricle; CVP, central venous pressure; BP, blood pressure; LVEDD, left ventricular end-diastolic diameter; PAP, pulmonary arterial pressure; PCWP, pulmonary capillary wedge pressure; LVAD, left ventricular assist device; ICU, intensive care unit; OR, odds ratio