Mid-term outcomes with the use of extracorporeal membrane oxygenation for cardiopulmonary failure secondary to massive pulmonary embolism. (28th July 2020)

• Record Type: Journal Article
• Authors: Sertic, Federico; Diagne, Dieynaba; Chavez, Lexy; Richards, Thomas; Berg, Ashley; Acker, Michael; Giri, Jay S; Szeto, Wilson Y; Khandhar, Sameer; Gutsche, Jacob; Pugliese, Steven; Fiorilli, Paul; Rame, Eduardo; Bermudez, Christian
• Is Part Of: European journal of cardio-thoracic surgery. Volume 58:Number 5(2020)
• Page Start: 923
• Page End: 931
• Publication Date: 2020-07-28
• Subjects: Pulmonary embolism -- Extracorporeal membrane oxygenation -- Cardiogenic shock -- Thrombolytic therapy -- Outcomes; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa189
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: There has been increasing interest in using extracorporeal membrane oxygenation (ECMO) to rescue patients with pulmonary embolism (PE) in the advanced stages of respiratory or haemodynamic decompensation. We examined mid-term outcomes and risk factors for in-hospital mortality. METHODS: We conducted a retrospective study of 36 patients who required ECMO placement (32 veno-arterial ECMO, 4 veno-venous) following acute PE. Survival curves were estimated using the Kaplan–Meier method. Risk factors for in-hospital mortality were assessed by logistic regression analysis. Functional status and quality of life were assessed by phone questionnaire. RESULTS: Overall survival to hospital discharge was 44.4% (16/36). Two-year survival conditional to discharge was 94% (15/16). Two-year survival after veno-arterial ECMO was 39% (13/32). In patients supported with veno-venous ECMO, survival to discharge was 50%, and both patients were alive at follow-up. In univariable analysis, a history of recent surgery ( P = 0.064), low left ventricular ejection fraction ( P = 0.029), right ventricular dysfunction ≥ moderate at weaning ( P = 0.083), on-going cardiopulmonary resuscitation at ECMO placement ( P = 0.053) and elevated lactate at weaning ( P = 0.002) were risk factors for in-hospital mortality. In multivariable analysis, recent surgery ( P = 0.018) and low left ventricular ejection fraction at weaning ( P = 0.013) were independent factors associated with in-hospital mortality. At a median follow-up of 23 months, 10 patients responded to our phone survey; all had acceptable functional status and quality of life. CONCLUSIONS: Massive acute PE requiring ECMO support is associated with high early mortality, but patients surviving to hospital discharge have excellent mid-term outcomes with acceptable functional status and quality of life. ECMO can provide a stable platform to administer other intervention with the potential to improve outcomes. Risk factors for in-hospital mortality after PE and veno-arterial ECMO support were identified. Abstract : Pulmonary embolism (PE) remains a significant complication of peripheral venous thrombosis with a reported incidence of 60–70 cases per 100 000 people [1].