Living Evidence Synthesis Baseline Report. Hospital Universitario Vall d’Hebron. LE-IHD.
Creators: name: Rojas- Reyes, María
name: Salas-Gama, Karla
name: Ribera, Aida
name: Osorio, Dimelza
name: Bustillos, Percy
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: cardiac arrest
subject: cardiogenic shock
subject: circulatory assist devices mechanics
subject: Continuos update
subject: Epistemonikos L.OVE Platform
subject: Evidence-based medicine
subject: Evidence Synthesis
subject: Inform Health Decisions
subject: Living Evidence

description: Tittle: Efficacy and safety of mechanical circulatory support devices short-term ventricular assist device (VAD)/ventricular assist ECMO (VA-ECMO) in patients with acute cardiogenic shock and refractory cardiac arrest: A living overview. Authors: Karla Salas-Gama ORCID: https://orcid.org/0000-0003-4845-4899 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Dimelza Osorio ORCID: https://orcid.org/0000-0001-6166-647X Afilliation: Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Aida Ribera ORCID: https://orcid.org/0000-0002-2604-6328 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Percy Efrain Pantoja ORCID: https://orcid.org/0000-0003-4095-8988 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Mónica Ballesteros ORCID: https://orcid.org/0000-0001-5244-4795 Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Claudia Álvarez ORCID: https://orcid.org/0000-0002-9417-6845 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Aitor Uribarri ORCID: https://orcid.org/0000-0002-6911-7480 Afilliation: Cardiovascular Outcomes research and Epidemiology Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Ignacio Ferreira-González ORCID: https://orcid.org/0000-0002-1208-5561 Afilliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Soledad Romea ORCID: https://orcid.org/0000-0002-7832-369X Afilliation: Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Corresponding author: Aida Ribera Email address: aida.ribera@vhir.org Postal address: Cardiovascular Outcomes research and Epidemiology Unit, Vall d’Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Hospital Universitario Vall d’Hebron. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This living overview aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of short-term mechanical circulatory support devices and ventricular assist device (VAD) /ventricular assist ECMO (VA-ECMO) in patients with acute cardiogenic shock and refractory cardiac arrest. Design Living overview of reviews. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies,including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Mechanical assist devices for cardiovascular diseases”. Methods We conducted a rapid overview and generated a structured evidence summary with a pre-established format that includes key messages, a summary of the body of evidence (presented as an evidence matrix in Epistemonikos), a meta-analysis of all studies (when possible), a summary table of results with the method GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and a section of other considerations for decision making. Results We identified four systematic reviews that together included five randomized trials comparing VAD (TandemHeart or Impella) with respect to the best treatment option (ionotropes and/or aortic balloon counterpulsation in patients with cardiogenic shock). There are no studies evaluating the efficacy of ECMO or studies evaluating the efficacy of VAD/ECMO in situations of cardiac arrest. Results on costs or on quality of life are not reported either. The evidence provided by systematic reviews identified do not show benefit of VAD (TandemHeart or Impella) on mortality at 30 days or at six months and, instead, a higher rate of bleeding is observed. Conclusions Up to date it is not clear whether or not the Impella and Tandem-Heart circulatory assist devices reduce overall mortality at 30 days or at six months of follow-up, because the uncertainty of the existing evidence, evaluated as very low according to GRADE approach. Impella and Tandem-Heart type circulatory assist devices might slightly increase the risk of bleeding (low certainty evidence). It is not possible to clearly establish whether Impella and Tandem-Heart type circulatory support devices increase the risk of lower limb ischemia, fever or sepsis, because the certainty of the existing evidence has been assessed as very low due to impresicion. © 2022 Hospital Universitario Vall d’Hebron, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.