Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review
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Background: Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE. Methods: We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018. Results: Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n = 3), ECMO with thrombolysis (50.0%, n = 4) and ECMO with embolectomy (44.4%, n = 9). Conclusions: Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.
Abstract
Background: Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE. Methods: We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018. Results: Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n = 3), ECMO with thrombolysis (50.0%, n = 4) and ECMO with embolectomy (44.4%, n = 9). Conclusions: Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.
참고문헌 (19)
- Aissaoui N, "What’s new in severe pulmonary embolism?", Intensive Care Med, 45, pp.75~77 (2019)
- Konstantinides SV, "2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism", Eur Heart J, 35, pp.3033~3069 (2014)
- Jaff MR, "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension : a scientific statement from the American Heart Association", Circulation, 123, pp.1788~1830 (2011)
- Logan JK, "Evidencebased diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism", Am J Emerg Med, 32, pp.789~796 (2014)
- Yusuff HO, "Extracorporeal membrane oxygenation in acute massive pulmonary embolism : a systematic review", Perfusion, 30, pp.611~616 (2015)
- Corsi F, "Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation", Crit Care, 21, pp.76~ (2017)
- Meneveau N, "Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism : a multicentre series of 52 cases", Eur Heart J, 39, pp.4196~4204 (2018)
- Galiè N, "Extracorporeal cardiopulmonary support in acute high-risk pulmonary embolism : still waiting for solid evidence", Eur Heart J, 39, pp.4205~4207 (2018)
- Manier G, "Influence of cardiac output on oxygen exchange in acute pulmonary embolism", Am Rev Respir Dis, 145, pp.130~136 (1992)
- Mercat A, "Hemodynamic effects of fluid loading in acute massive pulmonary embolism", Crit Care Med, 27, pp.540~544 (1999)
- Capellier G, "Inhaled nitric oxide in patients with pulmonary embolism", Intensive Care Med, 23, pp.1089~1092 (1997)
- Szold O, "Inhaled nitric oxide improves pulmonary functions following massive pulmonary embolism : a report of four patients and review of the literature", Lung, 184, pp.1~5 (2006)
- Dolmatova EV, "Extracorporeal membrane oxygenation in massive pulmonary embolism", Heart Lung, 46, pp.106~109 (2017)
- Kjaergaard B, "Extracorporeal membrane oxygenation in lifethreatening massive pulmonary embolism", Perfusion (2019)
- George B, "A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support", Resuscitation, 122, pp.1~5 (2018)
- Sakuma M, "Percutaneous cardiopulmonary support for the treatment of acute pulmonary embolism : summarized review of the literature in Japan including our own experience", Ann Vasc Dis, 2, pp.7~16 (2009)
- Maggio P, "Extracorporeal life support for massive pulmonary embolism", J Trauma, 62, pp.570~576 (2007)
- Leacche M, "Modern surgical treatment of massive pulmonary embolism : results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach", J Thorac Cardiovasc Surg, 129, pp.1018~1023 (2005)
- Wan S, "Thrombolysis compared with heparin for the initial treatment of pulmonary embolism : a meta-analysis of the randomized controlled trials", Circulation, 110, pp.744~749 (2004)