Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in re...

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Bibliographic Details
Published in:Vascular medicine (London, England) England), 2018-02, Vol.23 (1), p.60-64
Main Authors: Ain, David L, Albaghdadi, Mazen, Giri, Jay, Abtahian, Farhad, Jaff, Michael R, Rosenfield, Kenneth, Roy, Nathalie, Villavicencio-Theoduloz, Mauricio, Sundt, Thoralf, Weinberg, Ido
Format: Article
Language:English
Subjects:
Catheters
Computed tomography
Echocardiography
Embolism
Embolisms
Extracorporeal membrane oxygenation
Heart
Heart diseases
Medical instruments
Mortality
Oxygenation
Patients
Pulmonary arteries
Pulmonary embolisms
Risk
Ventricle
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Summary:Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era (n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era (p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.
ISSN:1358-863X
1477-0377
DOI:10.1177/1358863X17739697