Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism

Kjærgaard, Benedict; Kristensen, Jens; Sindby, Jesper Eske; Neergaard, Susanne de; Rasmussen, Bodil Steen

doi:10.1177/0267659119830014

Cited by 34 publications

(33 citation statements)

References 22 publications

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“…Furthermore, pulmonary embolism is the leading etiology among patients with good outcome. Pulmonary embolism causes acute right heart failure, and veno-arterial ECMO could be a highly effective treatment for this condition [25,26]. The results of our study emphasize the importance of appropriate etiologic diagnosis and the prediction of the potential for good brain recovery during cardiac arrest.…”

Section: Discussionmentioning

confidence: 66%

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Tanimoto

Sugiyama

Tanabe

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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Section: Discussionmentioning

confidence: 66%

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Tanimoto

Sugiyama

Tanabe

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…Of 960 records identified and screened at title/abstract level, 30 were examined for full text, of which 16 studies enrolling a total of 533 participants were included (Figure 1). 4,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis

et al. 2020

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High-risk pulmonary embolism (PE) requires hemodynamic and respiratory support along with reperfusion strategies. Recently updated European guidelines assign a low class of recommendation to extracorporeal membrane oxygenation (ECMO) for high-risk PE. This systematic review assessed clinical outcomes after ECMO in high-risk PE. We searched electronic databases including PubMed, Embase and Web of Science from January 2000 to April 2020. Efficacy outcomes included in-hospital survival with good neurological outcome and survival at follow-up. Safety outcomes included lower limb ischemia and hemorrhagic and ischemic stroke. Where possible (absence of high heterogeneity), meta-analyses of outcomes were undertaken using a random-effects model. We included 16 uncontrolled case-series (533 participants). In-hospital survival with good neurological outcome ranged between 50% and 95% while overall survival at follow-up ranged from 35% to 95%, both with a major degree of heterogeneity (I2 > 70%). The prevalence of lower limb ischemia was 8% (95% CI 3% to 15%). The prevalence of stroke (either hemorrhagic or ischemic) was 11% (95% CI 3% to 23%), with notable heterogeneity (I² = 63.35%). Based on currently available literature, it is not possible to draw definite conclusions on the usefulness of ECMO for high-risk PE. Prospective, multicenter, large-scale studies or nationwide registries are needed to best define the role of ECMO for high-risk PE. PROSPERO registration ID: CRD42019136282.

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“…Among the 421 studies identified by the search strategy, 106 studies were deemed eligible and 21 studies were eventually included in the analysis, for a total population of 635 patients with acute high‐risk PE receiving ECMO support 11‐31 . Exclusion reasons were: overlapping populations ( n = 10), studies not focused on ECMO use in PE ( n = 4), commentary papers ( n = 3), studies not reporting outcome of interest ( n = 1), and case reports/cases series including < 4 patients ( n = 67).…”

Section: Resultsmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) represents a therapeutic option for cardiopulmonary support in patients with high‐risk pulmonary embolism (PE); however, no definite consensus exists on ECMO use in high‐risk PE. Hence, we aim to provide insights into its real‐world use pooling together all available published experiences. We performed a systematic review and pooled analysis of all published studies (up to April 17, 2020) investigating ECMO support in high‐risk PE. All studies including at least four patients were collectively analyzed. Study outcomes were early all‐cause death (primary endpoint) and relevant in‐hospital adverse events. A total of 21 studies were included in the pooled analysis (n = 635 patients). In this population (mean age 47.8 ± 17.3 years, 44.5% females), ECMO was indicated for cardiac arrest in 62.3% and immediate ECMO support was pursued in 61.9% of patients. Adjunctive reperfusion therapies were implemented in 57.0% of patients. Pooled estimate rate of early all‐cause mortality was 41.1% (95% CI 27.7%‐54.5%). The most common in‐hospital adverse event was major bleeding, with an estimated rate of 28.6% (95%CI 21.0%‐36.3%). At meta‐regression analyses, no significant impact of multiple covariates on the primary endpoint was found. In this systematic review of patients who received ECMO for high‐risk PE, pooled all‐cause mortality was 41.1%. Principal indication for ECMO was cardiac arrest, cannulation was chiefly performed at presentation, and major bleeding was the most common complication.

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Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism

Cited by 34 publications

References 22 publications

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

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