Abstract 10177: Optimal Reperfusion Strategy in Acute High-Risk Pulmonary Embolism Requiring Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

Abstract

Introduction: The optimal pulmonary revascularization strategy in acute high-risk pulmonary embolism (PE) requiring the implantation of extra corporeal membrane oxygenation (ECMO) remains controversial. Methods: We conducted a systematic review and meta-analysis of available evidence comparing mechanical reperfusion and other strategies, including systemic or catheter-directed thrombolysis and ECMO as stand-alone therapy, with regard to mortality and bleeding outcomes. Results: The literature search identified 835 studies, 17 of which were included, totaling 321 PE patients with ECMO. Overall, 31.1% were treated with mechanical pulmonary reperfusion, while 78.9% received other strategies. The mortality rate was 23.0% in the mechanical reperfusion group and 43.1% in the other strategy group. The pooled OR for mortality with mechanical reperfusion was 0.46 (95%CI, 0.213-0.997; I 2 = 28.3%) versus other reperfusion strategies (Figure). The rate of bleeding in PE patients under ECMO was 29.1% in the mechanical reperfusion group and 26.0% in the other reperfusion group (OR, 1.09; 95% CI, 0.46-2.54; I 2 , 0.0%) among 10 eligible studies with available bleeding data. The meta-regression model did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy” and “ECMO implantation before pulmonary reperfusion therapy”, and outcomes. Conclusions: The results of the present meta-analysis and meta-regression suggest that mechanical reperfusion, notably by surgical embolectomy, yields the best results, regardless of the timing of ECMO implantation in the reperfusion timeline, and regardless of whether thrombolysis has been administered or not.