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Eur Heart J. 2018 Dec 14;39(47):4196-4204. doi: 10.1093/eurheartj/ehy464.

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

Author information

1
Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon, France.
2
EA3920, University of Burgundy Franche-Comté, 19 rue Ambroise Paré, Besançon, France.
3
Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou and Université Paris Descartes, 20 rue Leblanc, Paris, France.
4
Medical Intensive Care Unit, University Hospital Jean Minjoz, Boulevard Fleming, Besancon, France.
5
Service de Médecine Intensive et Réanimation Brabois, Institut Lorrain du Coeur et des Vaisseaux, CHRU de Nancy, Rue du Morvan, Vandoeuvre les Nancy, France.
6
U1116, Faculté de Médecine de Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre les Nancy, France.
7
Pôle Anesthésie Réanimation, Hôpital Michallon, CHU Grenoble Alpes, Avenue Maquis du Grésivaudan, La Tronche, France.
8
Department of Critical Care Unit, Hôpital Européen-Georges-Pompidou (HEGP), Assistance Publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, Paris, France.
9
Université Paris-Descartes, Inserm U970, 56 rue Leblanc, Paris, France.
10
Surgical Intensive Care Unit, Hôpital Européen-Georges-Pompidou (HEGP), Assistance Publique-hôpitaux de Paris (AP-HP), 20 rue Leblanc, Paris, France.
11
Cardiothoracic Intensive Care Department, Amiens University Hospital, Amiens, France.
12
INSERM U1088, Jules Verne University of Picardy, Chemin du Thil, Amiens, France.
13
Surgical Intensive Care Unit and Department of Anesthesiology, University Hospital Jean Minjoz, Boulevard Fleming, Besancon, France.
14
Service de Réanimation médicale et toxicologique, Hôpital Lariboisière, Assistance Publique-hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, Paris Cedex 10, France.
15
Inserm UMR-S 942, Hôpital Lariboisière, 41 Boulevard de la Chapelle, Paris Cedex 10, France.
16
Service de Réanimation médicale, Hôpital Henri Mondor, Assistance Publique-hôpitaux de Paris (AP-HP), 51 avenue du Maréchal de Lattre de Tassigny, Créteil Cedex, France.
17
Centre de Réanimation, CHU de Lille-Hôpital Salengro, Rue Emile Laine, Lille Cedex, France.
18
Institut du Thorax Curie-Montsouris, L'Institut Mutualiste Montsouris, 42 boulevard Jourdan, Paris, France.
19
Hôpitaux Universitaires de Strasbourg, 1 Quai Louis Pasteur, Strasbourg, France.
20
Service de réanimation médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.

Abstract

Aims:

The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy.

Methods and results:

From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred and twenty-eight patients were treated without ECMO; 52 (mean age 47.6 years) underwent ECMO. Overall 30-day mortality was 48.3% [95% confidence interval (CI) 41-56] (87/180); 43% (95% CI 34-52) (55/128) in those treated without ECMO vs. 61.5% (95% CI 52-78) (32/52) in those with ECMO (P = 0.008). In patients undergoing ECMO, 30-day mortality was 76.5% (95% CI 57-97) (13/17) for ECMO + fibrinolysis, 29.4% (95% CI 51-89) (5/17) for ECMO + surgical embolectomy, and 77.7% (95% CI 59-97) (14/18) for ECMO alone (P = 0.004). Among patients with ECMO, 20 (38.5%, 95% CI 25-52) had a major bleeding event in-hospital; without significant difference across groups.

Conclusion:

In patients with high-risk PE, those with ECMO have a more severe presentation and worse prognosis. Extracorporeal membrane oxygenation in patients with failed fibrinolysis and in those with no reperfusion seems to be associated with particularly unfavourable prognosis compared with ECMO performed in addition to surgical embolectomy. Our findings suggest that ECMO does not appear justified as a stand-alone treatment strategy in PE patients, but shows promise as a complement to surgical embolectomy.

PMID:
30137303
DOI:
10.1093/eurheartj/ehy464

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