Table_1_Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis.DOCX

ObjectiveStudies on extracorporeal membrane oxygenation (ECMO) with and without an intra-aortic balloon pump (IABP) for cardiogenic shock (CS) have been published, but there have been no meta-analyses that compare the efficacy of these two cardiac support methods. This meta-analysis evaluated the outcomes of these two different treatment measures.
MethodsThe PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials databases were searched until March 2022. Studies that were related to ECMO with or without IABP in patients with CS were screened. Quality assessments were evaluated with the methodological index for nonrandomized studies (MINORS). The primary outcome was in-hospital survival, while the secondary outcomes included duration of ECMO, duration of ICU stay, infection/sepsis, and bleeding. Revman 5.3 and STATA software were used for this meta-analysis.
ResultsIn total, nine manuscripts with 2,573 patients were included in the systematic review. CS patients who received ECMO in combination with IABP had significantly improved in-hospital survival compared with ECMO alone (OR = 1.58, 95% CI = 1.26–1.98, P < 0.0001). However, there were no significant differences in the duration of ECMO (MD = 0.36, 95% CI = −0.12–0.84, P = 0.14), duration of ICU stay (MD = −1.95, 95% CI = −4.05–0.15, P = 0.07), incidence of infection/sepsis (OR = 1.0, 95% CI = 0.58–1.72, P = 1.0), or bleeding (OR = 1.28, 95% CI = 0.48–3.45, P = 0.62) between the two groups of patients with CS.
ConclusionECMO combined with IABP can improve in-hospital survival more effectively than ECMO alone in patients with CS.

### 研究背景与目的
目前已有针对心源性休克（cardiogenic shock, CS）患者使用联合或不联合主动脉内球囊反搏（intra-aortic balloon pump, IABP）的体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）的相关研究发表，但尚无针对这两种心脏支持手段的疗效对比的荟萃分析。本项荟萃分析旨在评估这两种不同治疗方案的临床结局。

### 研究方法
本研究检索了PubMed、Embase、Cochrane图书馆、Web of Science及Clinical Trials数据库，检索时限截至2022年3月。筛选纳入针对心源性休克患者使用联合或不联合IABP的ECMO治疗的相关研究。采用非随机研究方法学指数（methodological index for nonrandomized studies, MINORS）对纳入研究进行质量评价。本研究的主要结局指标为住院生存率，次要结局指标包括ECMO支持时长、ICU停留时长、感染/脓毒症发生率及出血发生率。本荟萃分析采用Revman 5.3及STATA软件完成数据分析。

### 研究结果
本系统综述共纳入9篇文献，涉及2573例患者。相较于仅使用ECMO治疗的患者，联合IABP与ECMO治疗的心源性休克患者住院生存率显著提升（比值比OR=1.58，95%置信区间CI=1.26~1.98，P<0.0001）。但两组患者在ECMO支持时长（均数差MD=0.36，95%CI=-0.12~0.84，P=0.14）、ICU停留时长（MD=-1.95，95%CI=-4.05~0.15，P=0.07）、感染/脓毒症发生率（OR=1.0，95%CI=0.58~1.72，P=1.0）及出血发生率（OR=1.28，95%CI=0.48~3.45，P=0.62）方面均无显著统计学差异。

### 研究结论
在心源性休克患者的治疗中，联合使用IABP与ECMO相较于单纯ECMO治疗，可更有效地提升患者的住院生存率。