Veno-Arterial Extracorporeal Membrane Oxygenation for Pulmonary Embolism after Systemic Thrombolysis

被引:11
作者
Prasad, Nikhil K. [1 ]
Boyajian, Gregory [2 ]
Tran, Douglas [2 ]
Shah, Aakash [2 ]
Jones, Kevin M. [3 ,4 ]
Madathil, Ronson J. [2 ]
Deatrick, K. Barry [2 ]
Cires-Drouet, Rafael [5 ]
Kaczorowski, David J. [2 ]
机构
[1] Univ Maryland, Sch Med, Dept Surg, Div Gen Surg, Baltimore, MD 21201 USA
[2] Univ Maryland, Sch Med, Dept Surg, Div Cardiac Surg, Baltimore, MD 21201 USA
[3] Univ Maryland, Sch Med, Dept Emergency Med, Baltimore, MD 21201 USA
[4] Univ Maryland, Sch Med, Program Trauma, R Adams Cowley Shock Trauma Ctr, Baltimore, MD 21201 USA
[5] Univ Maryland, Sch Med, Dept Surg, Div Vasc Surg, Baltimore, MD 21201 USA
基金
美国国家卫生研究院;
关键词
Extracorporeal membrane oxygenation; Pulmonary embolism; Fibrinolytic agents; THROMBOSIS; OUTCOMES; THERAPY; SCORE; RISK;
D O I
10.1053/j.semtcvs.2021.04.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Massive pulmonary embolism (PE) is a life-threatening condition with a high mortality. Both systemic thrombolytics and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have been used in the management of massive PE. However, the safety of VA- ECMO in the setting of recent thrombolytic administration is not clear. The purpose of this study is to analyze the outcomes of patients who received VA-ECMO in the setting of systemic thrombolytics (ST). A single institution retrospective study of PE patients treated with VA-ECMO between December 2015 and December 2020 was performed. Patients who received ST were compared with those who did not receive ST. Outcomes, including mortality, major bleeding, duration of mechanical ventilation, need for renal replacement therapy, and length of hospital stay, were compared. A total of 83 patients with PE required VA-ECMO support and 18 of these received systemic thrombolytics. There was no statistically significant difference in survival to discharge between the patients who received ST compared with those who did not (88.9% vs 84.6%; p = 0.94). Major bleeding events occurred more often in patients who received ST (61.1% vs 26.2%; p = 0.01). There was no significant difference in time on mechanical ventilation, need for renal replacement therapy, or length of stay between the groups. Reasonable survival can be achieved despite an increased frequency of major bleeding events in patients that receive ST prior to VA-ECMO for PE. ST administration should not be considered an absolute contraindication to VA-ECMO. Further multi-center studies are needed to corroborate these findings. © 2021 Elsevier Inc.
引用
收藏
页码:549 / 557
页数:9
相关论文
共 25 条
[1]   Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature [J].
Al-Bawardy, Rasha ;
Rosenfield, Kenneth ;
Borges, Jorge ;
Young, Michael N. ;
Albaghdadi, Mazen ;
Rosovsky, Rachel ;
Kabrhel, Christopher .
PERFUSION-UK, 2019, 34 (01) :22-28
[2]   Identification of intermediate-risk patients with acute symptomatic pulmonary embolism [J].
Bova, Carlo ;
Sanchez, Olivier ;
Prandoni, Paolo ;
Lankeit, Mareike ;
Konstantinides, Stavros ;
Vanni, Simone ;
Jimenez, David .
EUROPEAN RESPIRATORY JOURNAL, 2014, 44 (03) :694-703
[3]   Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage A Meta-analysis [J].
Chatterjee, Saurav ;
Chakraborty, Anasua ;
Weinberg, Ido ;
Kadakia, Mitul ;
Wilensky, Robert L. ;
Sardar, Partha ;
Kumbhani, Dharam J. ;
Mukherjee, Debabrata ;
Jaff, Michael R. ;
Giri, Jay .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 311 (23) :2414-2421
[4]   Life-threatening massive pulmonary embolism rescued by venoarterialextracorporeal membrane oxygenation [J].
Corsi, Fillipo ;
Lebreton, Guillaume ;
Brechot, Nicolas ;
Hekimian, Guillaume ;
Nieszkowska, Ania ;
Trouillet, Jean-Louis ;
Luyt, Charles-Edouard ;
Leprince, Pascal ;
Chastre, Jean ;
Combes, Alain ;
Schmidt, Matthieu .
CRITICAL CARE, 2017, 21
[5]   Vasoactive Inotropic Score (VIS) as Biomarker of Short-Term Outcomes in Adolescents after Cardiothoracic Surgery [J].
Garcia, Richard U. ;
Walters, Henry L., III ;
Delius, Ralph E. ;
Aggarwal, Sanjeev .
PEDIATRIC CARDIOLOGY, 2016, 37 (02) :271-277
[6]   A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support [J].
George, Bennet ;
Parazino, Marc ;
Omar, Hesham R. ;
Davis, George ;
Guglin, Maya ;
Gurley, John ;
Smyth, Susan .
RESUSCITATION, 2018, 122 :1-5
[7]   Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) [J].
Goldhaber, SZ ;
Visani, L ;
De Rosa, M .
LANCET, 1999, 353 (9162) :1386-1389
[8]   Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension [J].
Jaff, Michael R. ;
McMurtry, M. Sean ;
Archer, Stephen L. ;
Cushman, Mary ;
Goldenberg, Neil ;
Goldhaber, Samuel Z. ;
Jenkins, J. Stephen ;
Kline, Jeffrey A. ;
Michaels, Andrew D. ;
Thistlethwaite, Patricia ;
Vedantham, Suresh ;
White, R. James ;
Zierler, Brenda K. .
CIRCULATION, 2011, 123 (16) :1788-1830
[9]   Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report [J].
Kearon, Clive ;
Akl, Elie A. ;
Ornelas, Joseph ;
Blaivas, Allen ;
Jimenez, David ;
Bounameaux, Henri ;
Huisman, Menno ;
King, Christopher S. ;
Morris, Timothy A. ;
Sood, Namita ;
Stevens, Scott M. ;
Vintch, Janine R. E. ;
Wells, Philip ;
Woller, Scott C. ;
Moores, Lisa .
CHEST, 2016, 149 (02) :315-352
[10]   Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism [J].
Konstantinides, S ;
Geibel, A ;
Heusel, G ;
Heinrich, F ;
Kasper, W .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (15) :1143-1150