Background:Veno-arterial extracorporeal life support (VA-ECLS) is widely used to treat refractory cardiogenic shock. However, increased left ventricular (LV) afterload in VA-ECLS can worsen pulmonary congestion and compromise myocardial recovery. Our objectives were to explore the efficacy, safety, and optimal timing of adjunctive LV venting strategies.Methods:A systematic search was performed on Medline, EMBASE, PubMed, CDSR, CCRCT, CINAHL, ClinicalTrials.Gov, and WHO ICTRP from inception until January 2019 for all relevant studies, including LV venting. Data were analyzed for mortality and weaning from VA-ECLS on the basis of timing of LV venting, along with adverse complications.Results:A total of 7995 patients were included from 62 observational studies, wherein 3458 patients had LV venting during VA-ECLS. LV venting significantly improved weaning from VA-ECLS (odds ratio, 0.62 [95% CI, 0.47–0.83]; P=0.001) and reduced short-term (30 day; risk ratio [RR], 0.86 [95% CI, 0.77–0.96]; P=0.008) but not in-hospital (RR, 0.92 [95% CI, 0.83–1.01] P=0.09) or long-term (6 months; RR, 0.96 [95% CI, 0.90–1.03]; P=0.27) mortality. Early (<12 hours; RR, 0.86 [95% CI, 0.75–0.99]; P=0.03) but not late (≥12 hours; RR, 0.99 [95% CI, 0.71–1.38]; P=0.93) LV venting significantly reduced short-term mortality. Patients with LV venting spent more time on VA-ECLS (3.6 versus 2.8 days, P<0.001), and mechanical ventilation (7.1 versus 4.6 days, P=0.013). With the exception of hemolysis (RR, 2.18 [95% CI, 1.58–3.01]; P<0.00001), overall adverse events did not differ.Conclusions:LV venting, especially if done early (<12 hours), appears to be associated with an increased success of weaning and reduced short-term mortality. Future studies are required to delineate the importance of any or early LV venting adjuncts on mortality and morbidity outcomes.

中文翻译：

---

成人心源​​性休克静脉-动脉体外生命支持期间左心室通气的最佳策略和时机：系统评价和荟萃分析。

背景：静脉动脉体外生命支持系统（VA-ECLS）被广泛用于治疗难治性心源性休克。但是，VA-ECLS中左心室（LV）后负荷增加会加重肺部充血并损害心肌恢复。我们的目标是探索辅助性LV排泄策略的有效性，安全性和最佳时机。方法：从开始到1月，对Medline，EMBASE，PubMed，CDSR，CCRCT，CINAHL，ClinicalTrials.Gov和WHO ICTRP进行系统搜索2019年所有相关研究，包括LV排气。结果：62例观察性研究共纳入了7995例患者，其中3458例在VA-ECLS期间进行了LV通气，其中VA-ECLS的死亡率和断奶时间与不良并发症有关。P = 0.001）和短期减少（30天；风险比[RR]，0.86 [95％CI，0.77-0.96]；P = 0.008），但未在医院内（RR，0.92 [95％CI，0.83– 1.01] P = 0.09）或长期（6个月； RR，0.96 [95％CI，0.90–1.03]；P = 0.27）死亡率。早期（<12小时; RR，0.86 [95％CI，0.75–0.99]; P = 0.03），但不晚（≥12小时; RR，0.99 [95％CI，0.71–1.38]; P = 0.93）大大降低了短期死亡率。LV通气患者在VA-ECLS上花费的时间更多（3.6天对2.8天，P <0.001）和机械通气（7.1天对4.6天，P = 0.013）。除了溶血（RR，2.18 [95％CI，1.58–3.01]；P<0.00001），总体不良事件无差异。结论：LV排气，尤其是如果早期（<12小时）进行，似乎与断奶成功率增加和短期死亡率降低相关。需要进一步的研究来确定任何或早期左室通气辅助手段对死亡率和发病率结果的重要性。