# Hemoadsorption in Heart Failure Requiring Mechanical Circulatory Support—A Systematic Review and Meta-Analysis

## TL;DR

This study reviews whether hemoadsorption improves outcomes for heart failure patients using mechanical support devices, finding mixed results and limited evidence.

## Contribution

The paper provides a systematic review and meta-analysis of hemoadsorption's impact on survival in heart failure patients with mechanical circulatory support.

## Key findings

- Hemoadsorption during LVAD implantation was linked to higher mortality and respiratory issues in some studies.
- Most ECMO studies found no survival benefit from hemoadsorption, though one small study reported lower mortality.
- Results are limited by small sample sizes and retrospective study designs.

## Abstract

Left ventricular assist devices (LVAD) and extracorporeal
membrane oxygenation (ECMO) are well established therapies in heart failure (HF)
management. Their use is generally associated with a sudden increase in
inflammatory mediators, which are often already elevated in patients with HF
prior to device implantation. An exaggerated release of proinflammatory cytokines
is associated with organ dysfunction and increased mortality. Hemoadsorption has
been shown to reduce inflammatory mediators during cardiopulmonary bypass.

To investigate the role of hemoadsorption during the
management of acute or chronic heart failure with mechanical circulatory support
and its impact on survival.

We systematically searched MEDLINE
selecting all studies comparing the use of hemoadsorption during LVAD
implantation or veno-arterial (v.a.) ECMO therapy. Records were screened by two
different investigators. Reports without a control group and duplicates were
excluded.

Our search delivered six studies. One was randomized
and five were retrospective studies, of which three were risk-adjusted. During
LVAD implantation, one study showed no difference in mortality but higher
incidence of respiratory insufficiency in the hemoadsorption group (54% vs 30%,
p = 0.024) and the other study found higher mortality in the
hemoadsorption group (33% vs 0%, p = 0.01). During ECMO therapy, three
of four studies including the randomized one found no difference in survival or
major adverse cardiac events between the hemoadsorption and the control groups.
Only one study found lower mortality in the hemoadsorption group (20% vs 60%.
p = 0.02).

The results of this literature review
suggest that the use of hemoadsorption in patients undergoing LVAD implantation
might be associated with higher morbidity and mortality. The majority of studies
on the use of hemoadsorption during v.a. ECMO therapy showed no effect on
mortality or organ dysfunction, while only one small study showed that
hemoadsorption was able to reduce mortality. The results are limited by the
retrospective nature and the small sample sizes of the majority of the studies
included.