Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

Meneveau, Nicolas; Guillon, Benoı̂t; Planquette, Benjamin; Piton, Gaël; Kimmoun, Antoine; Gaide-Chevronnay, Lucie; Aïssaoui, Nadia; Neuschwander, Arthur; Zogheib, Élie; Dupont, Hervé; Pili-Floury, Sébastien; Ecarnot, Fiona; Schiele, François; Deye, Nicolas; Prost, Nicolas de; Favory, Raphaël; Girard, Philippe; Cristinar, Mircea; Ferré, Alexis; Meyer, Guy; Capellier, Gilles; Sanchez, Olivier

doi:10.1093/eurheartj/ehy464

Cited by 154 publications

(121 citation statements)

References 25 publications

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“…In a large series of 180 high-risk PE, 52 patients received VA-ECMO: as a standalone therapy (n=18), after failed fibrinolysis (n=20) or before/after embolectomy (n=7/n=10). Mortality was higher in patients under VA-ECMO (62% vs. 43%, p=0.008) with the patients in the VA-ECMO + embolectomy group (30-day mortality 29%) having the most favorable outcome (19).…”

Section: Massive Pulmonary Embolismmentioning

confidence: 95%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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Purpose of review: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications and discusses the results of recent case series and trials. Recent findings: VA-ECMO is utilized as a bridge to "decision" that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, refractory cardiac arrest are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

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Section: Massive Pulmonary Embolismmentioning

confidence: 95%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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“…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.…”

Section: Mechanical Circulatory Support and Oxygenationmentioning

confidence: 99%

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

et al. 2019

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“…Furthermore, venoarterial extracorporeal membrane oxygenation (ECMO) was only used in a very limited number of patients. Increasing availability of mechanical cardiopulmonary support systems might improve the prognosis of high-risk patients with cardiac shock (although currently available data indicate a benefit of ECMO only as a complement to surgical embolectomy [26]).…”

Section: Trends In Risk-adjusted Managementmentioning

confidence: 99%

Temporal trends in management and outcome of pulmonary embolism: a single-centre experience

et al. 2019

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Background Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age, 70 years (IQR 56-77) years, 53% female] consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6-14) to 7 (IQR 4-15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014-08/2016) compared to first 6 years (09/2008-08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. Conclusion In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.

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Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

Cited by 154 publications

References 25 publications

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

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

Temporal trends in management and outcome of pulmonary embolism: a single-centre experience

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