Screening pulmonary angiogram and the effect on anticoagulation strategies in severe respiratory failure patients on venovenous extracorporeal membrane oxygenation

Background Venovenous extracorporeal membrane oxygenation in the treatment of severe respiratory failure in adults continues to increase with survival improving; however, it remains associated with serious complications. Objective The aim of this study was to evaluate the prevalence of pulmonary embolism (PE) in patients with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV ECMO) and in those managed with conventional mechanical ventilation. Methods A single-center, observational cohort, retrospective study was undertaken of patients with severe respiratory failure managed with conventional ventilation or requiring ECMO in a tertiary referral university teaching hospital. Results We identified 343 patients with severe respiratory failure between January 2014 and December 2017. VV ECMO was used to support 290 patients and 53 were managed by conventional mechanical ventilation. The prevalence of PE was 9.6% (33/343), of which those supported with VV ECMO was 10% (29/290) and conventional ventilation 7.5% (4/53). There was no difference in survival rates between cohorts with PE versus no PE (ECMO survival to discharge P = .56; conventional ventilation survival to discharge P = .21). Conclusions The prevalence of pulmonary embolism in severe respiratory failure has important clinical implications for both short and long-term anticoagulation strategies. Routine screening pulmonary angiogram is warranted in this cohort.