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Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39–50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33–60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3–18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8–26.4 I2 = 0) were higher. They also had lower values of creatinine [MD –0.59 (95%CI: –0.9 to –0.2) I2 = 7%], lactate [MD –3.1 (95%CI: –5.4 to –0.7) I2 = 89%], and creatine kinase [–2779.5 (95%CI: –5387 to –171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: –0.2–36.2) I2 = 91%, and MD 15.9% (95%CI 11.9–20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW. [ABSTRACT FROM AUTHOR]

The present study was conducted to investigate the obesity paradox and assess the effect of body mass index (BMI) on early and late clinical outcomes after cardiac surgery. Cohort study with a retrospective analysis of prospectively collected data. Single-institution cardiology medical center. The study comprised consecutive patients undergoing cardiac surgery from January 2009 to January 2019. Patients were divided into the following 4 groups defined by BMI: underweight (UW) (≤18.5 kg/m2): 0.5%, n = 27; normal weight (18.5-25 kg/m2): 25.7%, n = 1,393; overweight (OW) (>25-30 kg/m2): 44.7%, n = 2,423; and obese (OB) (≥30 kg/m2): 29.1%, n = 1,576. No interventions. A multivariate analysis was used to compare clinical outcomes among the different BMI groups. Overall 1-year survival of patients in the BMI categories was determined by the Kaplan-Meier method and compared using the log rank test. The study included 5,419 patients. The BMI groups were significantly different regarding presurgical variables. Mortality according to BMI exhibited a reverse J-shaped relationship: 7.4% in the UW group, 5.2% in the normal weight group, 3.2% in the OW group, and 4.3% in the OB group (p = 0.016). Low- cardiac- output syndrome and bleeding were more frequent in the UW group, whereas mediastinitis and hyperglycemia were more common in the OB group. After adjusting for other risk factors, BMI was not an independent predictor of in-hospital mortality. One-year follow-up was completed in 95% of the patients, and the analysis of long-term mortality did not show a difference among the BMI categories (p log rank = 0.16). OW patients had a lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables were taken into account, BMI did not have independent effect on in-hospital and 1-year mortality. [ABSTRACT FROM AUTHOR]

Introduction: Veno-arterial extracorporeal membrane oxygenation may be used to support patients with refractory cardiogenic shock. Many patients can be successfully weaned, the ability of some medications to facilitate weaning from veno-arterial extracorporeal membrane oxygenation were reported. To date, there are limited studies investigating the impact of levosimendan on veno-arterial extracorporeal membrane oxygenation weaning. The objective of this systematic review and meta-analysis was to assess the effects of levosimendan on successful weaning from veno-arterial extracorporeal membrane oxygenation and survival in adult patients with cardiogenic shock. Methods: We performed a systematic review and meta-analysis (PubMed, the Cochrane Library, and the International Clinical Trials Registry Platform published from the year 2000 onwards) investigating whether levosimendan offers advantages compared to standard therapy or placebo, in cardiogenic shock adult patients treated with veno-arterial extracorporeal membrane oxygenation. The primary outcome was veno-arterial extracorporeal membrane oxygenation successful weaning, whereas secondary outcome was all-cause mortality at the longest follow-up available. We pooled risk ratio and 95% confidence interval using fixed and random effects models according to the heterogeneity. Results: A total of five non-randomized clinical trials comprising 557 patients were included, 299 patients for levosimendan and 258 patients for control groups. The pooled prevalence of veno-arterial extracorporeal membrane oxygenation successful weaning was 61.4% (95% confidence interval 39.8-82.9%), and all-cause mortality was 36% (95% confidence interval 29.6-48.8%). There was a significant increase in veno-arterial extracorporeal membrane oxygenation successful weaning with levosimendan compared to the controls (risk ratio = 1.42 (95% confidence interval 1.12-1.8), p for effect = 0.004, I2 = 71%). A decrease risk of all-cause mortality in the levosimendan group was also observed, risk ratio = 0.62 (95% confidence interval 0.44-0.88), p for effect = 0.007, I2 = 36%. Conclusion: The use of levosimendan on adult patients with cardiogenic shock may facilitate the veno-arterial extracorporeal membrane oxygenation weaning and reduce all-cause mortality. Few articles of this topic are available, and prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of levosimendan in this setting. [ABSTRACT FROM AUTHOR]