The online version of this article (doi:10.1186/s13054-017-1655-8) contains supplementary material, which is available to authorized users.
Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation.
ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006–2015). Hospital- discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted.
Seventeen high-risk PE patients [median age 51 (range 18–70) years, Simplified Acute Physiology Score II (SAPS II) 78 (45–95)] were placed on VA-ECMO for 4 (1–12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0–106) mmHg, 6.99 (6.54–7.37) and 13 (4–19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4–69) months post-ICU discharge.
VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting.
Additional file 1: Supplementary methods (DOCX 18 kb)13054_2017_1655_MOESM1_ESM.docx
Additional file 2: (A) Computed tomography (CT) scan showing a saddle embolus extending into the left and right pulmonary arteries. (B) The same patient’s follow-up CT scan obtained 9 days later on VA-ECMO. (C) CT scan obtained 15 days after ICU admission with successful ECMO weaning after 10 days on circulatory support. (DOCX 462 kb)13054_2017_1655_MOESM2_ESM.docx
Additional file 3: Flow diagram illustrating the identification, selection, and exclusion of articles used in the review. (DOCX 95 kb)13054_2017_1655_MOESM3_ESM.docx
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- Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation
- BioMed Central
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