Acute Crit Care.  2019 May;34(2):148-154. 10.4266/acc.2019.00500.

Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review

• Oh YN
• Oh DK
• Koh Y
• Lim CM
• Huh JW
• Lee JS
• Jung SH
• Kang PJ
• Hong SB

• KMID: 2449369
• DOI: http://doi.org/10.4266/acc.2019.00500

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 high-risk 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.

Keyword

embolectomy; extracorporeal membrane oxygenation; pulmonary embolism; shock; thrombolytic therapy; treatment outcome

MeSH Terms

Embolectomy
Extracorporeal Membrane Oxygenation*
Heart Arrest
Humans
Male
Medical Records
Mortality
Pulmonary Embolism*
Retrospective Studies
Shock
Thrombolytic Therapy
Treatment Outcome

Figure

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  Figure 1. (A) A timeline of treatment strategies and 30-day mortalities. (B) A flowchart of treatment strategies and 30-day mortalities with causes of death. PE: pulmonary embolism; ECMO: extracorporeal membrane oxygenation; ECPR: extracorporeal cardiopulmonary resuscitation.

• 

  Figure 2. Thirty-day mortality. CI: confidence interval.

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