Short-term outcomes of intra-aortic balloon pump combined with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis

The effectiveness of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock or cardiac arrest remains controversial. The aim of this systematic review and meta-analysis was to investigate the short-term clinical outcomes of IABP combined with VA-ECMO versus VA-ECMO alone. We searched PubMed, Embase, and the Cochrane Library for English language articles published from inception to August 18, 2018. Observational studies comparing IABP combined with VA-ECMO with VA-ECMO were considered eligible for the current study. Twelve observational studies with 3704 patients were included. In the IABP combined with VA-ECMO group mortality was 59.7%, compared with 65.8% in the VA-ECMO alone group. The risk ratio (RR) for this comparison was 0.90 (95% confidence interval [CI], 0.80-1.02; P = 0.107; 59.7% vs. 65.8%). In the one-way sensitivity analysis for estimating the effect of each study on mortality, omission of each study did not make a significant difference. Furthermore, the proportion of patients weaned from VA-ECMO was significantly higher in IABP combined VA-ECMO group than in the VA-ECMO alone group (RR, 1.28; 95% CI, 1.21-1.35; P < 0.001; 77.9% vs. 61.2%). IABP combined with VA-ECMO could improve success rate of weaning from VA-ECMO, but did not reduce in-hospital mortality in patients with cardiogenic shock or cardiac arrest.