Frontiers in Cardiovascular Medicine (Jun 2022)

Extracorporeal Membrane Oxygenation—First Strategy for Acute Life-Threatening Pulmonary Embolism

  • Zhenjie Liu,
  • Jinyi Chen,
  • Xin Xu,
  • Fen Lan,
  • Minzhi He,
  • Changming Shao,
  • Yongshan Xu,
  • Pan Han,
  • Yibing Chen,
  • Yongbin Zhu,
  • Man Huang

DOI
https://doi.org/10.3389/fcvm.2022.875021
Journal volume & issue
Vol. 9

Abstract

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BackgroundBoth venoarterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous mechanical thrombectomy (PMT) are increasingly used to treat acute life-threatening pulmonary embolism (PE). However, there are little data regarding their effectiveness. This study aimed to present the short-term outcomes after managing nine patients with acute life-threatening massive or submassive PE by VA-ECMO with or without complemented PMT and propose a preliminary treatment algorithm.MethodsThis study was a single-center retrospective review of a prospectively maintained registry. It included nine consecutive patients with massive or submassive pulmonary embolism who underwent VA-ECMO for initial hemodynamic stabilization, with or without PMT, from August 2018 to November 2021.ResultsMean patient age was 54.7 years. Four of nine patients (44.4%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All cannulations (100%) were successfully performed percutaneously. Overall survival was 88.9% (8 of 9 patients). One patient died from a hemorrhagic stroke. Of the survivors, the median ECMO duration was 8 days in patients treated with ECMO alone and 4 days in those treated with EMCO and PMT. Five of nine patients (55.6%) required concomitant PMT to address persistent right heart dysfunction, with the remaining survivors (44.4%) receiving VA-ECMO and anticoagulation alone. For survivors receiving VA-ECMO plus PMT, median hospital lengths of stay were 7 and 13 days, respectively.ConclusionsAn ECMO-first strategy complemented with PMT can be performed effectively and safely for acute life-threatening massive or submassive PE. VA-ECMO is feasible for initial stabilization, serving as a bridge to therapy primarily in inoperable patients with massive PE. Further evaluation in a larger cohort of patients is warranted to assess whether VA-ECMO plus PMT may offer an alternative or complementary therapy to thrombolysis or surgical thrombectomy.Type of ResearchSingle-center retrospective review of a prospectively maintained registry.

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