Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism

Abstract

Purpose of reviewSurgery is an important option to consider in patients with massive and submassive pulmonary emboli. Earlier intervention, better patient selection, improved surgical techniques and the use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) have contributed to improve the safety of surgery for pulmonary emboli. Recent findingsVA ECMO is rapidly changing the initial management of patients with massive pulmonary emboli, providing an opportunity for stabilization and optimization before intervention. The early and long-term consequences of acute pulmonary emboli are better understood, in particular with regard to the risks of chronic thromboembolic pulmonary hypertension (CTEPH), an entity that should be identified in the acute setting as much as possible. The presence of chronic thromboembolic pulmonary disease can be associated with persistent haemodynamic instability despite removal of the acute thrombi, particularly if pulmonary hypertension is established. The pulmonary embolism response team (PERT) is an important component in the management of massive and submassive acute pulmonary emboli to determine the best treatment options for each patient depending on their clinical presentation.

Surgical pulmonary embolectomy: state of the art

“…In recent years, temporary mechanical circulatory support using extracorporeal membrane oxygenation (ECMO) has been successfully practised in critically ill patients with acute PE [ 40 ]. However, the existing literature examines case series descriptions only, and thus requires further efficacy evaluation [ 39 , 41 , 42 ].…”