Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 30;10(15):3376.
doi: 10.3390/jcm10153376.

Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

Raphaël Giraud  1   2 , Matthieu Laurencet  1 , Benjamin Assouline  1   2 , Amandine De Charrière  1   2 , Carlo Banfi  2   3 , Karim Bendjelid  1   2
Affiliations

Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

Raphaël Giraud et al. J Clin Med. .

Abstract

Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy.

Material and methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed.

Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65-91.57, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022-0.520, p = 0.006).

Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.

Keywords: VA-ECMO; cardiogenic shock; massive acute pulmonary embolism; thrombolysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Inotrope score change between pre and post-VA-ECMO cannulation according to patients’ 30-day status. * p < 0.001 between pre-ECMO and after 24 h on ECMO, ** p = 0.004 between survivors and non-survivors.
Figure 2
Figure 2
Kaplan–Meier curves for the 30-day survival of patients with MAPE implanted with only an ECMO or treated with fibrinolysis and/or catheter thromboaspiration before ECMO implantation. HR: Hazard Ratio.
See this image and copyright information in PMC

References

    1. Kucher N., Rossi E., De Rosa M., Goldhaber S.Z. Massive pulmonary embolism. Circulation. 2006;113:577–582. doi: 10.1161/CIRCULATIONAHA.105.592592. - DOI - PubMed
    1. Konstantinides S.V., Meyer G., Becattini C., Bueno H., Geersing G.J., Harjola V.P., Huisman M.V., Humbert M., Jennings C.S., Jimenez D., et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) Eur. Heart J. 2020;41:543–603. doi: 10.1093/eurheartj/ehz405. - DOI - PubMed
    1. Meneveau N., Guillon B., Planquette B., Piton G., Kimmoun A., Gaide-Chevronnay L., Aissaoui N., Neuschwander A., Zogheib E., Dupont H., et al. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: A multicentre series of 52 cases. Eur. Heart J. 2018;39:4196–4204. doi: 10.1093/eurheartj/ehy464. - DOI - PubMed
    1. Pineton de Chambrun M., Brechot N., Combes A. The place of extracorporeal life support in cardiogenic shock. Curr. Opin. Crit. Care. 2020;26:424–431. doi: 10.1097/MCC.0000000000000747. - DOI - PubMed
    1. Kalra R., Kosmopoulos M., Goslar T., Raveendran G., Bartos J.A., Yannopoulos D. Extracorporeal cardiopulmonary resuscitation for cardiac arrest. Curr. Opin. Crit. Care. 2020;26:228–235. doi: 10.1097/MCC.0000000000000717. - DOI - PMC - PubMed

LinkOut - more resources