Abstract
BackgroundVeno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE.MethodsTwenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated.ResultsSixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 h after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in ten patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001).ConclusionsECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.
Highlights
Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE)
Nineteen patients had visualized pulmonary artery thrombus by using computed tomography (CT) scan, one patient had a diagnosis based on the presence of impaired gas exchange, hemodynamic instability, and right heart thrombus, and one patient was diagnosed based on high clinical probability and echocardiographic finding of right ventricular (RV) dilation without other plausible cause
Two hospitalized patients remained asymptomatic until sudden cardiac arrest occurred and four patients presented with cardiogenic shock on arrival to the emergency department
Summary
Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). Acute pulmonary embolism (PE) is a major cause of sudden death worldwide and is often difficult to diagnose because of the variable clinical presentations, in patients with pre-existing cardiopulmonary disease [1]. Massive or high risk PE, defined as PE resulting in hemodynamic instability, carries a high mortality rate, ranging from 30% for patients with cardiogenic shock to 70% for those that required cardiopulmonary resuscitation (CPR) [2]. Veno-arterial extracorporeal membrane oxygenation (ECMO) is a reliable mechanical circulatory support device to decrease right ventricular (RV) volume overload, stabilize hemodynamic status, and provide gas exchange [6], and may be considered as either a bridge to definitive reperfusion therapy or as a stand-alone treatment strategy [7]. Evidence for use of ECMO is limited to small case series [6,7,8] and the role of ECMO is not established
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