Age Does Not Matter: Utilization of Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism in the Elderly Population

Abstract

<h3>Purpose</h3> Management of massive and submassive pulmonary embolism (PE) remains a challenge. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a useful strategy in select patients with pulmonary emboli (PE) to provide hemodynamic support; however, age remains a relative contraindication based on prior literature as safety is controversial. <h3>Methods</h3> We retrospectively reviewed all patients with pulmonary emboli who were placed on peripheral VA-ECMO from 2015- 2021 at a single institution. Patients were identified and stratified into two groups with an age cutoff of 65 years of age. Demographics, pre-cannulation data, ECMO data, and echocardiographic results were obtained. Primary endpoints included 30-day, 6-month, and one-year survival. <h3>Results</h3> Sixty-nine patients <65 years of age (median age 58) and twenty patients ≥65 of age (median age 69) received VA-ECMO for PE. Hypertension incidence was higher in the ≥65 group; there were no differences in sex, BMI, pre-cannulation arrest, or in pre-cannulation ejection fraction or presence of right ventricular dysfunction. The median duration on ECMO was 5 days in both groups (p=0.503). 14.5% (10/69) of patients <65 and 25.0% (5/20) of patients ≥65 required surgical embolectomy after 5-7 days of VA-ECMO support (p=0.313). There was no difference in 30-day survival (91.3% (63/69, A) in <65 vs 90.0% (18/20) in ≥65, p=<0.999), 6-month survival (92.3% (60/65) in <65 vs 85% (17/20) in ≥65, p=0.385), and one-year survival (92.1% (58/63, B) in <65 vs 83.3% (15/18) in ≥65, p=0.367). There was no difference in ICU or hospital length of stay, need for renal replacement therapy, and rate of stroke between the groups. <h3>Conclusion</h3> There is no difference in 30-day, 6-month, or one-year survival in patients with a PE who are supported with VA-ECMO as compared to younger patients in our experience. As such, age should not be a contraindication for VA-ECMO use for cardiopulmonary support in management of pulmonary embolism.