Extracorporeal membrane oxygenation for large pulmonary emboli

George, Timothy J.; Sheasby, Jenelle; Sawhney, Rahul; DiMaio, J. Michael; Afzal, Aasim; Gable, Dennis; Sayfo, Sameh

doi:10.1080/08998280.2023.2171699

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…Of 2318 references screened, we sought the full text for 370 potentially relevant publications. Some 351 full-text articles were available, from which we included 39 observational studies totalling 1,177,998 patients (6409 ECMO and 1,171,589 non-ECMO) in the meta-analysis ( Figure 1 , Table S4 ) [ 9 , 10 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], of which 13 were cohort studies and 26 were case series. There were 14 studies from Europe, 14 from Asia, and 11 from North America.…”

Section: Resultsmentioning

confidence: 99%

“… Subgroup analysis of mortality for patients receiving extracorporeal membrane oxygenation alone compared to ECMO with catheter-directed therapies (CDT), surgical embolectomy (SE), or systemic thrombolysis (ST) for pulmonary embolism [ 9 , 10 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. …”

Section: Figurementioning

confidence: 99%

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Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

Boey,

Dhundi,

Ling

et al. 2023

JCM

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Background: The use of extracorporeal membrane oxygenation (ECMO) for high-risk pulmonary embolism (HRPE) with haemodynamic instability or profound cardiogenic shock has been reported. Guidelines currently support the use of ECMO only in patients with cardiac arrest or circulatory collapse and in conjunction with other curative therapies. We aimed to characterise the mortality of adults with HRPE treated with ECMO, identify factors associated with mortality, and compare different adjunct curative therapies. Methods: We conducted a systematic review and meta-analysis, searching four international databases from their inception until 25 June 2023 for studies reporting on more than five patients receiving ECMO for HRPE. Random-effects meta-analyses were conducted. The primary outcome was in-hospital mortality. A subgroup analysis investigating the outcomes with curative treatment for HRPE was also performed. The intra-study risk of bias and the certainty of evidence were also assessed. This study was registered with PROSPERO (CRD42022297518). Results: A total of 39 observational studies involving 6409 patients receiving ECMO for HRPE were included in the meta-analysis. The pooled mortality was 42.8% (95% confidence interval [CI]: 37.2% to 48.7%, moderate certainty). Patients treated with ECMO and catheter-directed therapy (28.6%) had significantly lower mortality (p < 0.0001) compared to those treated with ECMO and systemic thrombolysis (57.0%). Cardiac arrest prior to ECMO initiation (regression coefficient [B]: 1.77, 95%-CI: 0.29 to 3.25, p = 0.018) and pre-ECMO heart rate (B: −0.076, 95%-CI: −0.12 to 0.035, p = 0.0003) were significantly associated with mortality. The pooled risk ratio when comparing mortality between patients on ECMO and those not on ECMO was 1.51 (95%-CI: 1.07 to 2.14, p < 0.01) in favour of ECMO. The pooled mortality was 55.2% (95%-CI: 47.7% to 62.6%), using trim-and-fill analysis to account for the significant publication bias. Conclusions: More than 50% of patients receiving ECMO for HRPE survive. While outcomes may vary based on the curative therapy used, early ECMO should be considered as a stabilising measure when treating patients with HRPE. Patients treated concurrently with systemic thrombolysis have higher mortality than those receiving ECMO alone or with other curative therapies, particularly catheter-directed therapies. Further studies are required to explore ECMO vs. non-ECMO therapies in view of currently heterogenous datasets.

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Section: Resultsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

Boey,

Dhundi,

Ling

et al. 2023

JCM

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“…PE impacts nearly 900,000 individuals annually in the United States (US) [ 9 ], resulting in an estimated 100,000 deaths each year [ 10 ]. Early hospitalization and 30-day mortality are driven by multiple factors, chief among them the presence of right ventricular dysfunction and/or hemodynamic instability [ 4 , 11 , 12 , 13 , 14 ]. The survival rate for patients with severe pulmonary embolism who require extracorporeal membrane oxygenation device (ECMO) ranges between 38% and 67% [ 15 , 16 , 17 , 18 ].…”

Section: Incidence Predictors Of Mortalitymentioning

confidence: 99%

“…Cardiac arrest before ECMO cannulation is predictive of poorer outcomes [ 16 , 18 ]. Evidence supporting other MCS devices, such as Impella RP or Tandem Heart (Protek Duo), is limited and primarily based on case series [ 11 , 19 , 20 ]…”

Section: Incidence Predictors Of Mortalitymentioning

confidence: 99%

Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism

Ellauzi,

Erdem,

Salam

et al. 2024

JCM

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Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management.

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Extracorporeal membrane oxygenation for large pulmonary emboli

Cited by 2 publications

References 8 publications

Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism

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