Massive pulmonary embolism (PE) can cause hemodynamic instability leading to high mortality. Extracorporeal life support (ECLS) has been increasingly used as a bridge to definitive therapy. This systematic review investigates the outcomes of ECLS for the treatment of massive PE.
Electronic search was performed to identify all relevant studies published on ECLS use in patients with PE. 50 case series or reports were selected comprising 128 patients with acute massive PE who required ECLS. Patient-level data were extracted for statistical analysis.
Median patient age was 50 [36, 63] years and 41.3% (50/121) were male. 67.2% (86/128) of patients presented with cardiac arrest. Median heart rate was 126 [118, 135] and median systolic pulmonary artery pressure (sPAP) was 55 [48, 69] mmHg. The majority of ECLS included veno-arterial ECLS [97.1% (99/102)]. Median ECLS time was 3 [2, 6] days. 43.0% (55/128) patients received systemic thrombolysis, 22.7% (29/128), received catheter-guided thrombolysis, and 37.5% (48/128) underwent surgical embolectomy. 85.1% (97/114) were weaned off ECLS. Post-ECLS complications included bleeding in 23.4% (30/128), acute renal failure in 8.6% (11/128), dialysis in 6.3% (8/128), heparin-induced thrombocytopenia in 3.1 (4/128), and extremity hypoperfusion in 2.3% (3/128). The most common cause of death was shock at 30.3% (10/33). The median length of hospital stay was 22 [11, 39] days including 8 [5, 13] intensive care unit (ICU) days. The 30-day mortality rate was 22% (20/91).
ECLS is safe and effective therapy in unstable patients with acute massive pulmonary embolism and offers acceptable outcomes.
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- Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism.Exp Clin Cardiol. 2013; 18: 129-138
- Percutaneous cardiopulmonary bypass: application and indication for use.Ann Thorac Surg. 1989; 47: 121-123https://doi.org/10.1016/0003-4975(89)90252-X
- Catheter directed thrombolysis combined with ECMO for massive pulmonary emboli.Respir Med Case Rep. 2018; 25: 6-8https://doi.org/10.1016/j.rmcr.2018.05.029
- Extracorporeal life support for massive pulmonary embolism.J Trauma. 2007; 62: 570-576https://doi.org/10.1097/TA.0b013e318031cd0c
- Aggressive surgical treatment of acute pulmonary embolism with circulatory collapse.Ann Thorac Surg. 2012; 94: 785-791https://doi.org/10.1016/j.athoracsur.2012.03.101
- Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale.Thromb Haemost. 2000; 83: 657-660
- Guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J. 2008; 29: 2276-2315https://doi.org/10.1093/eurheartj/ehn310
- Extracorporeal life support: moving at the speed of light.Respir Care. 2011; 56 (discuiion 1453–6): 1445-1453https://doi.org/10.4187/respcare.01369
- Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology.J Thorac Dis. 2015; 7: E166-E176https://doi.org/10.3978/j.issn.2072-1439.2015.07.17
- Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock.Crit Care Med. 2008; 36: 1404-1411https://doi.org/10.1097/CCM.0b013e31816f7cf7
- A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support.Resuscitation. 2018; 122: 1-5https://doi.org/10.1016/j.resuscitation.2017.11.034
- Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases.Eur Heart J. 2018; 39: 4196-4204https://doi.org/10.1093/eurheartj/ehy464
- Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. A systematic review.Ann Am Thorac Soc. 2016; 13: 2242-2250https://doi.org/10.1513/AnnalsATS.201605-364SR
- Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients.Ann Thorac Surg. 2014; 97: 610-616https://doi.org/10.1016/j.athoracsur.2013.09.008
Published online: November 29, 2019
Accepted: November 19, 2019
Received in revised form: November 7, 2019
Received: August 20, 2019
Publication stageIn Press Journal Pre-Proof
© 2019 Published by Elsevier B.V.