Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism

A protocolized approach to veno-arterial extracorporeal membrane oxygenation for massive pulmonary embolism

“…Consistent with George et al, several published series of VA-ECMO for massive PE have described a mortality rate between 40 and 60% [2][3][4]. The authors of this study are to be commended for their large experience over just a 4-year period.…”

“…There was a 53% survival to discharge, and a lactic acid level < 6 mmol/L was predictive of survival. Based on the results of this study, the authors felt that there were 3 groups who may not benefit from VA-ECMO: patients with 1) malignancy, 2) pre-cannulation cardiac arrest, and 3) lactate ≥6 mmol/L.Consistent with George et al, several published series of VA-ECMO for massive PE have described a mortality rate between 40 and 60% [2][3][4]. The authors of this study are to be commended for their large experience over just a 4-year period.…”

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

“…The temporary use of mechanical cardiopulmonary support, mostly with veno-arterial extracorporeal membrane oxygenation (ECMO), may be helpful in patients with high-risk PE, and circulatory collapse or cardiac arrest. Survival of critically ill patients has been described in a number of case series [247][248][249][250][251][252], but no RCTs testing the efficacy and safety of these devices in the setting of high-risk PE have been conducted to date. Use of ECMO is associated with a high incidence of complications, even when used for short periods, and the results depend on the experience of the centre as well as patient selection.…”

Reply to: A protocolized approach to veno-arterial extracorporeal membrane oxygenation for massive pulmonary embolism

“…Pasrija et al are to be commended for their findings demonstrating an in-hospital and 90-day survival outcome of 95% for a group of twenty patients with massive PE who received VA-ECMO treated with an established and detail-specific protocol [2]. This is a much higher reported survival than previous studies regarding the use of VA-ECMO in massive PE where mortality ranges from 40 to 60% and readers expecting similar results should be cautious [3][4][5]. Two main factors could contribute to this success.…”