Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

被引:33
|
作者
Scott, John Harwood [1 ]
Gordon, Matthew [1 ]
Vender, Robert [2 ]
Pettigrew, Samantha [2 ]
Desai, Parag [1 ]
Marchetti, Nathaniel [1 ]
Mamary, Albert James [1 ]
Panaro, Joseph [3 ]
Cohen, Gary [3 ]
Bashir, Riyaz [4 ]
Lakhter, Vladimir [4 ]
Roth, Stephanie [5 ]
Zhao, Huaqing [6 ]
Toyoda, Yoshiya [7 ]
Criner, Gerard [1 ]
Moores, Lisa [8 ]
Rali, Parth [1 ]
机构
[1] Lewis Katz Sch Med, Dept Thorac Med & Surg, Philadelphia, PA 19140 USA
[2] Temple Univ Hosp & Med Sch, Dept Internal Med, Philadelphia, PA 19140 USA
[3] Lewis Katz Sch Med, Dept Intervent Radiol, Philadelphia, PA USA
[4] Lewis Katz Sch Med, Dept Cardiovasc Med, Philadelphia, PA USA
[5] Temple Univ, Dept Biomed & Res Serv, Ginsburg Hlth Sci Lib, Philadelphia, PA 19122 USA
[6] Lewis Katz Sch Med, Dept Clin Sci, Philadelphia, PA USA
[7] Lewis Katz Sch Med, Dept Surg, Philadelphia, PA USA
[8] F Edward Hebert Sch Med, Dept Internal Med, Bethesda, MD USA
关键词
extracorporeal membrane oxygenation; methods; heart arrest; etiology; therapy; pulmonary embolism; complications; thrombolytic therapy; treatment outcome; PERCUTANEOUS CARDIOPULMONARY SUPPORT; LIFE-SUPPORT; SUCCESSFUL RESUSCITATION; VENOUS THROMBOEMBOLISM; SURGICAL EMBOLECTOMY; THROMBOLYTIC THERAPY; CARDIOGENIC-SHOCK; ESC GUIDELINES; ECMO; MANAGEMENT;
D O I
10.1097/CCM.0000000000004828
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
OBJECTIVE: Management of patients experiencing massive pulmonary embolism-related cardiac arrest is controversial. Venoarterial extracorporeal membranous oxygenation has emerged as a potential therapeutic option for these patients. We performed a systematic review assessing survival and predictors of mortality in patients with massive PE-related cardiac arrest with venoarterial extracorporeal membranous oxygenation use. DATA SOURCES: A literature search was started on February 16, 2020, and completed on March 16, 2020, using PubMed, Embase, Cochrane Central, Cinahl, and Web of Science. STUDY SELECTION: We included all available literature that reported survival to discharge in patients managed with venoarterial extracorporeal membranous oxygenation for massive PE-related cardiac arrest. DATA EXTRACTION: We extracted patient characteristics, treatment details, and outcomes. DATA SYNTHESIS: About 301 patients were included in our systemic review from 77 selected articles (total screened, n = 1,115). About 183 out of 301 patients (61%) survived to discharge. Patients (n = 51) who received systemic thrombolysis prior to cannulation had similar survival compared with patients who did not (67% vs 61%, respectively; p = 0.48). There was no significant difference in risk of death if PE was the primary reason for admission or not (odds ratio, 1.62; p = 0.35) and if extracorporeal membranous oxygenation cannulation occurred in the emergency department versus other hospital locations (odds ratio, 2.52; p = 0.16). About 53 of 60 patients (88%) were neurologically intact at discharge or follow-up. Multivariate analysis demonstrated three-fold increase in the risk of death for patients greater than 65 years old (adjusted odds ratio, 3.08; p = 0.03) and six-fold increase if cannulation occurred during cardiopulmonary resuscitation (adjusted odds ratio, 5.67; p = 0.03). CONCLUSIONS: Venoarterial extracorporeal membranous oxygenation has an emerging role in the management of massive PE-related cardiac arrest with 61% survival. Systemic thrombolysis preceding venoarterial extracorporeal membranous oxygenation did not confer a statistically significant increase in risk of death, yet age greater than 65 and cannulation during cardiopulmonary resuscitation were associated with a three- and six-fold risks of death, respectively.
引用
收藏
页码:760 / 769
页数:10
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