Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism

Hobohm, Lukas; Sagoschen, Ingo; Habertheuer, Andreas; Valerio, Luca; Wild, Johannes; Schmidt, Frank; Gori, Tommaso; Münzel, Thomas; Konstantinides, Stavros; Keller, Karsten

doi:10.1016/j.resuscitation.2021.10.007

Cited by 65 publications

(63 citation statements)

References 24 publications

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“…Corresponding with our findings, Hobohm et al, retrospectively analyzed 1,172,354 individuals hospitalized with PE, of whom 2,197 (0.2%) received ECMO assistance. Cardiac arrest occurred in 77,196 people (6.5%), necessitating CPR indicating that patients who received embolectomy or thrombolysis together with VA-ECMO or VA-ECMO alone had a lower risk of death compared to thrombolysis alone [30]. In addition, a meta-analysis study by Karami et al, has suggested patients ≤ 60 years who received VA-ECMO plus surgical embolectomy seemed to have better outcomes but no survival benefits were observed for acute PE therapies [31].…”

Section: Discussionmentioning

confidence: 99%

Gender Disparities in Outcomes Following Pulmonary Embolism Treatment in the Intensive Care Unit; A Multi-center Retrospective Cohort Study

2022

International Journal of Anesthesia and Critical Care

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Background: There is a limited literature on the survival rates of male and female patients in surviving pulmonary embolism in Intensive Care Units (ICU). As such, this calls for study of its disparities. Our study aims to compare gender disparities in outcomes following pulmonary embolism treatment in the ICU. Methods:A multicenter retrospective cohort study was conducted between January 2013 and December 2020 where we analyzed and compared gender disparities followed by outcomes. Data were retrieved from hospital databases, and patient medical records of P.E patients admitted to the intensive care unit (ICU) of six hospitals in China. Results:The study included 100 confirmed pulmonary embolism patients with a mean age of 62 ± 14 years. Of them, 55 were female with co-morbidity chronic heart disease (20% vs. 4.4%), cigarette smokers (9.1% vs. 51.1%) all had (p<0.05) as compared to males. Also, females had APACHE II score of (17 ± 12 vs. 15 ± 10, p>0.05), 30-days and 6-months deaths, 4(7%) and 6(11%) with (p>0.05), respectively. Interestingly, sex-based outcomes on kidney injury revealed a statistically significant difference between females and males (p<0.05). In addition, there were also ssignificant differences in blood pressure between male and female non-survivors (p<0.05). Moreover, for non-survivors, factors attributed to mortality in descending order, were as follows;

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Section: Discussionmentioning

confidence: 99%

Gender Disparities in Outcomes Following Pulmonary Embolism Treatment in the Intensive Care Unit; A Multi-center Retrospective Cohort Study

2022

International Journal of Anesthesia and Critical Care

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“…However, these methods are limited in their availability and are used as last life-saving therapy option only ( 27 ). However, if reperfusion treatment is not effective or not available in the setting of haemodynamic instability, data indicate that the temporary use of mechanical circulatory support via ECMO as a bridging therapy might improve outcomes until pharmacological or mechanical thrombolysis or embolectomy is applied ( 47 ). In patients with acute PE and pregnancy ECMO has not been widely used.…”

Section: Treatment Of Acute Pulmonary Embolism In Pregnant Women—high...mentioning

confidence: 99%

Pulmonary Embolism and Pregnancy—Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Hobohm

Farmakis

Münzel

et al. 2022

Front. Cardiovasc. Med.

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Diagnosis of acute PE in pregnant women with haemodynamic instability is following the general integrated risk-adapted diagnostic algorithm and starts with bedside echocardiography to assess RV function. If RV dysfunction is identified, a prompt and immediate reperfusion without further imaging should be initiated. Although pregnancy is listed as a relative contraindication of systemic thrombolysis, in pregnant women with acute PE and haemodynamic instability thrombolysis must be considered. In those cases, other treatment strategies as surgical embolectomy or catheter-directed low-dose thromboylysis or percutaneous thrombectomy should be taken into consideration as well. A multidisciplinary team with experience of PE management in pregnancy should be consulted to reach consensus on the best treatment approach.

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“…In einer Metaanalyse zu eCPR ohne cCPR-Kontrollgruppe bei Kreislaufstillstand durch Lungenembolie überlebten 65 % (64 von 99) der Patienten, 88 % davon mit neurologisch gutem Überleben, wobei in der Literatur eine Mortalität von bis zu 90 % angegeben wird [ 16 ]. Eine Registerstudie zu Lungenembolie und Kreislaufstillstand zeigte einen Überlebensvorteil für den sehr kleinen Anteil der Patienten mit eCPR und Thrombolyse, eCPR und Thrombektomie, aber auch eCPR allein ohne Reperfusionstrategie gegenüber der Behandlung mit Thrombolyse allein [ 17 ]. Eine ELSO-Registerstudie der Jahre 1997–2017 fand in 42 schwangeren Patienten mit eCPR eine Überlebensrate von 55 % [ 18 ].…”

Section: Evidenz Und Outcomeunclassified

Extrakorporale Reanimation – Kriterien, Bedingungen, Outcome

Magnet

Poppe

2022

Med Klin Intensivmed Notfmed

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ZusammenfassungFür ausgewählte Patienten, in denen die konventionelle kardiopulmonale Reanimation (cCPR) erfolglos bleibt, sprechen die europäischen Leitlinien zur Reanimation 2021 erstmals eine Empfehlung zur extrakorporalen Reanimation (eCPR) als mögliche Rettungstherapie aus. Die eCPR wird im therapierefraktären Kreislaufstillstand etabliert, um Diagnostik und Therapie reversibler Ursachen, wie Herzinfarkt, Lungenembolie, akzidentielle Hypothermie, Intoxikationen mit herzwirksamen Substanzen und akute Hypoxie, zu ermöglichen. Selektionskriterien für eCPR umfassen prognostische Reanimationsfaktoren, wie beobachteter Kreislaufstillstand, Start von Reanimationsmaßnahmen in < 5 min, schockbarer Erstrhythmus, Zeichen effektiver cCPR wie Lebenszeichen während der Reanimation, anhaltendes Kammerflimmern, intermittierende Phasen von Spontankreislauf oder anhaltendes endtidales CO2 > 10 mm Hg, Patientenalter und Gesundheitszustand. Die Zeitspanne vom Kreislaufstillstand bis zur eCPR ist eine der wichtigsten Determinanten für neurologisch gutes Überleben und sollte < 60 min liegen. Für die Einhaltung dieser Zielvorgabe muss eine entschlossene „Load-and-Go“-Strategie mit frühzeitiger Patientenselektion und raschem Transport unter mechanischer cCPR in ein eCPR-Zentrum verfolgt werden, oder es wird versucht, die eCPR präklinisch zum Einsatz zu bringen. Zwei randomisierte kontrollierte eCPR-Studien demonstrierten Überlebensraten von 43 % bzw. 31,5 % bei Patienten mit anhaltendem Kammerflimmern bzw. kardialem Kreislaufstillstand. Ob diese Ergebnisse außerhalb einzelner hochspezialisierter Zentren anwendbar sind, ist wie die Frage nach der besten präklinischen und innerklinischen Strategie Gegenstand zukünftiger Studien.

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Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism

Cited by 65 publications

References 24 publications

Gender Disparities in Outcomes Following Pulmonary Embolism Treatment in the Intensive Care Unit; A Multi-center Retrospective Cohort Study

Gender Disparities in Outcomes Following Pulmonary Embolism Treatment in the Intensive Care Unit; A Multi-center Retrospective Cohort Study

Pulmonary Embolism and Pregnancy—Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Extrakorporale Reanimation – Kriterien, Bedingungen, Outcome

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