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. 2024 Aug;50(8):1287-1297.
doi: 10.1007/s00134-024-07501-9. Epub 2024 Jun 24.

Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study

David Levy  1   2 , Ouriel Saura  1   2 , Maria Teresa Passarelli  2   3 , Manuela Lucenteforte  2   4 , Guillaume Lebreton  1   5 , Adrien Bougle  6 , Antoine Monsel  7   8 , Sofia Ortuno  2 , Yoël Benitha  2 , Nadjib Hammoudi  1   9 , Benjamin Assouline  2   10 , Matthieu Petit  2 , Melchior Gautier  2 , Lucie Le Fevre  2 , Marc Pineton de Chambrun  1   2   11 , Charles Juvin  1   5 , Juliette Chommeloux  1   2 , Charles-Edouard Luyt  1   2 , Guillaume Hékimian  1   2 , Pascal Leprince  1   5 , Alain Combes  1   2 , Matthieu Schmidt  12   13
Affiliations

Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study

David Levy et al. Intensive Care Med. 2024 Aug.

Abstract

Purpose: Despite systemic thrombolysis, a few patients with high-risk pulmonary embolism (PE) remain hemodynamically unstable. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a considerable lifesaving therapy but systemic thrombolysis before cannulation could carry a high risk of hemorrhage and alter the prognosis.

Methods: Between June 2012 and June 2023, we retrospectively analyzed from three intensive care units in Sorbonne University, ECMO-related complications and 90-day mortality for high-risk PE patients who received ECMO without previous systemic thrombolysis compared to those cannulated after systemic thrombolysis failure. Hospital discharge survivors were assessed for long-term health-related quality of life and echocardiographic evaluations.

Results: 72 high-risk PE patients [median age 48 (37-61) years, Simplified Acute Physiology Score II (SAPS II) 74 (60-85)] were placed on VA-ECMO for 5 (5-7) days. 31 (43%) patients underwent pre-ECMO thrombolysis (thrombolysis ECMO group, T +) compared to 41 patients (57%, no thrombolysis ECMO group, T-). There was more pre-ECMO cardiac arrest in the thrombolysis ECMO group (94% vs. 67%, p = 0.02). Ninety-day survival was not different between groups (39% vs 46%, log-rank test, p = 0.31). There was no difference in severe hemorrhages (61% vs 59%, p = 1). Twenty-five over 28 patients attended follow-up at a median time of 69 (52-95) months. Long-term quality of life was acceptable and none of them experienced chronic thromboembolic pulmonary hypertension.

Conclusions: Ninety-day survival and bleeding events rates did not differ in patients treated with VA-ECMO after systemic thrombolysis compared to those who were not. Recent systemic thrombolysis, as a single parameter, should not be considered as a contraindication for VA-ECMO in high-risk PE.

Keywords: ECMO-outcomes; Long-term outcomes; Pulmonary embolism; Thrombolysis.

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