Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
ECLS is safe and effective therapy in unstable patients with acute massive pulmonary
embolism and offers acceptable outcomes.
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Article info
Publication history
Published online: November 29, 2019
Accepted:
November 19,
2019
Received in revised form:
November 7,
2019
Received:
August 20,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Published by Elsevier B.V.
