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. 2022 Mar 2:9:799488.
doi: 10.3389/fcvm.2022.799488. eCollection 2022.

Efficacy and Safety of Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of High-Risk Pulmonary Embolism: A Retrospective Cohort Study

Hao-Yu Tsai  1 , Yu-Tang Wang  2 , Wei-Chieh Lee  3 , Hsu-Ting Yen  2 , Chien-Ming Lo  2 , Chia-Chen Wu  2 , Kwan-Ru Huang  2 , Yin-Chia Chen  2 , Jiunn-Jye Sheu  2 , Yen-Yu Chen  2
Affiliations

Efficacy and Safety of Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of High-Risk Pulmonary Embolism: A Retrospective Cohort Study

Hao-Yu Tsai et al. Front Cardiovasc Med. .

Abstract

Objectives: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly used to treat high-risk pulmonary embolism (PE). However, its efficacy and safety remain uncertain. This retrospective cohort study aimed to determine whether ECMO could improve the clinical outcomes of patients with high-risk PE.

Methods: Forty patients with high-risk PE, who were admitted to Kaohsiung Chang Gung Memorial Hospital between January 2012 and December 2019, were included in this study. Demographic data and clinical outcomes were compared between patients treated without ECMO (non-ECMO group) and those treated with ECMO (ECMO group). Appropriate statistical tools were used to compare variables between groups and the survival was analyzed using the Kaplan-Meier method.

Results: The overall in-hospital mortality rate was 55%, in which 65% (26/40) of patients presented with cardiac arrest with a mortality rate of 77%, which was higher than that of patients without cardiac arrest (14%). There was no significant difference in major complications and in-hospital mortality between the non-ECMO and ECMO groups. However, in subgroup analysis, compared with patients treated without ECMO, earlier ECMO treatment was associated with a reduced risk of cardiac arrest (P = 0.023) and lower in-hospital mortality (P = 0.036). A log-rank test showed a significantly higher cumulative overall survival in the earlier ECMO treatment group (P = 0.033).

Conclusions: In this retrospective cohort study, earlier ECMO treatment was associated with lower in-hospital mortality among unstable patients without cardiac arrest. Our findings suggest that ECMO can be considered as an initial treatment option for patients with high-risk PE in higher-volume hospitals.

Keywords: ECMO; cardiac arrest; pulmonary embolism; shock; sudden death.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of inclusion and exclusion criteria of this cohort study of Chang Gung Research Database from 2012 to 2019. AMI, acute myocardial infarction; CHF, congestive heart failure; DNR, do-not-resuscitate; PE, pulmonary embolism.
Figure 2
Figure 2
Flow chart of the treatment strategies and outcomes. CPR, cardiopulmonary resuscitation; ECMO, veno-arterial extracorporeal membrane oxygenation; PE, pulmonary embolism.
Figure 3
Figure 3
Flow chart of comparing the outcome in patients with and without earlier ECMO treatment. ECMO, veno-arterial extracorporeal membrane oxygenation.
Figure 4
Figure 4
The impact of earlier ECMO treatment on the overall survival of pulmonary embolism patients without sudden cardiac arrest. ECMO, veno-arterial extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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