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Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism

Aim of the study - Extracorporeal membrane oxygenation (ECMO) is considered a life-saving treatment option for patients in cardiogenic shock or cardiac arrest undergoing cardiopulmonary resuscitation (CPR) due to acute pulmonary embolism (PE). We sought to analyze use and outcome of ECMO with or wit...

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Main Authors: Hobohm, Lukas (Author) , Sagoschen, Ingo (Author) , Habertheuer, Andreas (Author) , Barco, Stefano (Author) , Valerio, Luca (Author) , Wild, Johannes (Author) , Schmidt, Frank P. (Author) , Gori, Tommaso (Author) , Münzel, Thomas (Author) , Konstantinides, Stavros (Author) , Keller, Karsten (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: Resuscitation
Year: 2022, Volume: 170, Pages: 285-292
ISSN:1873-1570
DOI:10.1016/j.resuscitation.2021.10.007
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.resuscitation.2021.10.007
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0300957221004032
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Author Notes:Lukas Hobohm, Ingo Sagoschen, Andreas Habertheuer, Stefano Barco, Luca Valerio, Johannes Wild, Frank P. Schmidt, Tommaso Gori, Thomas Münzel, Stavros Konstantinides, Karsten Keller
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Summary:Aim of the study - Extracorporeal membrane oxygenation (ECMO) is considered a life-saving treatment option for patients in cardiogenic shock or cardiac arrest undergoing cardiopulmonary resuscitation (CPR) due to acute pulmonary embolism (PE). We sought to analyze use and outcome of ECMO with or without adjunctive treatment strategies in patients with acute PE. - Methods - We retrospectively analyzed data on patient characteristics, treatments, and in-hospital outcomes for all PE patients (ICD-code I26) undergoing ECMO in Germany between 2005 and 2018. - Results - At total of 1,172,354 patients were hospitalized with PE; of those, 2,197 (0.2%) were treated with ECMO support. Cardiac arrest requiring cardiopulmonary resuscitation was present in 77,196 (6.5%) patients. While more than one fourth of those patients were treated with systemic thrombolysis alone (n = 20,839 patients; 27.0%), a minority of patients received thrombolysis and VA-ECMO (n = 165; 0.2%), embolectomy and VA-ECMO (n = 385; 0.5%) or VA-ECMOalone (n = 588; 0.8%). A multivariable logistic regression analysis indicated the lowest risk for in-hospital death in patients who received embolectomy in combination with VA-ECMO (OR, 0.50 [95% CI, 0.41-0.61], p < 0.001), thrombolysis and VA-ECMO (0.60 [0.43-0.85], p = 0.003) or VA-ECMO alone (0.68 [0.57-0.82], p < 0.001) compared to thrombolysis alone (1.04 [0.99-1.01], p = 0.116). - Conclusion - Our findings suggest that the use of VA-ECMO alone or as part of a multi-pronged reperfusion approach including embolectomy or thrombolysis might offer survival advantages compared to thrombolysis alone in patients with PE deteriorating to cardiac arrest.
Item Description:Gesehen am 18.05.2022
First published online: 12 October 2021
Physical Description:Online Resource
ISSN:1873-1570
DOI:10.1016/j.resuscitation.2021.10.007

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