National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism

Elbadawi, Ayman; Mentias, Amgad; Elgendy, Islam Y.; Mohamed, Ahmed H.; Syed, Mohammed Hz; Ogunbayo, Gbolahan; Olorunfemi, Odunayo; Gošev, Igor; Prasad, Sunil; Cameron, Scott J.

doi:10.1177/1358863x18824650

Cited by 46 publications

(50 citation statements)

References 23 publications

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“…In a retrospective study of 219 high-risk patients who were treated with ECMO, the majority of patients were male (67%) and female sex was found to be an independent predictor of mortality (OR, 2.19; 95% CI, 1.03-4.67), suggesting that women may be less likely to receive ECMO and women who do may have higher mortality. 102 DOACs have rapidly become the most common oral anticoagulant therapy for PE, replacing VKA in most situations, given their clinical efficacy and relative ease of administration. 103 The benefits of DOACs appear to be similar for men and women; there are no sex differences in the rates of recurrent VTE for patients on DOAC treatment.…”

Section: Treatment and Outcomes Of High-risk Pementioning

confidence: 99%

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

et al. 2021

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Acute pulmonary embolism (PE) affects over 600,000 Americans per year and is a common diagnostic consideration among emergency department patients. Although there are well-documented differences in the diagnosis, treatment, and outcomes of cardiovascular conditions, such as ischemic heart disease and stroke, the influence of sex and gender on PE remains poorly understood. The overall age-adjusted incidence of PE is similar in women and men, but women have higher relative rates of PE during early and mid-adulthood (ages 20-40 years); whereas, men have higher rates of PE after age 60 years. Women are tested for PE at far higher rates than men, yet women who undergo computed tomography pulmonary angiography are ultimately diagnosed with PE 35%-55% less often than men. Among those diagnosed with PE, women are more likely to have severe clinical features, such as hypotension and signs of right ventricular dysfunction. When controlled for PE severity, women are less likely to receive reperfusion therapies, such as thrombolysis. Finally, women have more bleeding complications for all types of anticoagulation. Further investigation of possible sex-specific diagnostic and treatment algorithms is necessary in order to more accurately detect and treat acute PE in non-pregnant adults.

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Section: Treatment and Outcomes Of High-risk Pementioning

confidence: 99%

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

et al. 2021

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“…Among the 421 studies identified by the search strategy, 106 studies were deemed eligible and 21 studies were eventually included in the analysis, for a total population of 635 patients with acute high‐risk PE receiving ECMO support 11‐31 . Exclusion reasons were: overlapping populations ( n = 10), studies not focused on ECMO use in PE ( n = 4), commentary papers ( n = 3), studies not reporting outcome of interest ( n = 1), and case reports/cases series including < 4 patients ( n = 67).…”

Section: Resultsmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) represents a therapeutic option for cardiopulmonary support in patients with high‐risk pulmonary embolism (PE); however, no definite consensus exists on ECMO use in high‐risk PE. Hence, we aim to provide insights into its real‐world use pooling together all available published experiences. We performed a systematic review and pooled analysis of all published studies (up to April 17, 2020) investigating ECMO support in high‐risk PE. All studies including at least four patients were collectively analyzed. Study outcomes were early all‐cause death (primary endpoint) and relevant in‐hospital adverse events. A total of 21 studies were included in the pooled analysis (n = 635 patients). In this population (mean age 47.8 ± 17.3 years, 44.5% females), ECMO was indicated for cardiac arrest in 62.3% and immediate ECMO support was pursued in 61.9% of patients. Adjunctive reperfusion therapies were implemented in 57.0% of patients. Pooled estimate rate of early all‐cause mortality was 41.1% (95% CI 27.7%‐54.5%). The most common in‐hospital adverse event was major bleeding, with an estimated rate of 28.6% (95%CI 21.0%‐36.3%). At meta‐regression analyses, no significant impact of multiple covariates on the primary endpoint was found. In this systematic review of patients who received ECMO for high‐risk PE, pooled all‐cause mortality was 41.1%. Principal indication for ECMO was cardiac arrest, cannulation was chiefly performed at presentation, and major bleeding was the most common complication.

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“…In massive PE, where blood pressure can be barely detectable, instigation of ECMO at the earliest timepoint appears to be a sound concept 35–37 . The failing heart does not fail purely because of afterload mechanics.…”

Section: What Is Needed Nowmentioning

confidence: 99%

“…The downsides of this, of course, include the nature of definitive treatment in this situation, which typically includes the use of systemic thrombolysis in the presence of large bore cannulae inserted into central veins in an unstable patient, with bleed risks apparent 35 . In an effort to minimize bleeding complications, ECMO could be combined with low-dose CDT to stabilize the sickest of PE patients, rather than considering full-dose systemic thrombolytic 36 …”

Section: What Is Needed Nowmentioning

confidence: 99%

Future perspectives in catheter-based treatment of pulmonary embolism

Sharp

Attallah

2019

European Heart Journal Supplements

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Pulmonary embolism is the third commonest cause of cardiovascular death globally. The majority of such patients present with low-risk features and can be managed with simple anticoagulation; however, a large group of patients exhibit evidence of right ventricular dysfunction on echocardiography or CT at the time of presentation and these patients are at risk of early haemodynamic compromise, particularly in those with abnormal cardiac biomarkers. Catheter-directed thrombolysis has been proposed as a treatment-strategy for patients with pulmonary embolism with evidence of acute right ventricular dysfunction. We review the current technologies in mainstream use, the evidence base in support of their use and discuss future research requirements in this area.

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National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism

Cited by 46 publications

References 23 publications

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

Future perspectives in catheter-based treatment of pulmonary embolism

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