Int J Heart Fail.  2020 Jul;2(3):187-194. 10.36628/ijhf.2020.0006.

In-Hospital Outcome in Patients Underwent Extracorporeal Membrane Oxygenation in Life-Threatening High-Risk Pulmonary Embolism

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
  • 3Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
  • 4Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
  • 5Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

Abstract

Background and Objectives
Acute pulmonary embolism(PE) has high mortality and morbidity. Although reperfusion therapies can be used in high-risk PE patients, a few patients remain in a highly hemodynamically unstable state. In these patients, extracorporeal membrane oxygenation (ECMO) can be used to restore tissue oxygenation and improve their hemodynamic status. We retrospectively assessed the outcomes of ECMO in patients with high-risk PE.
Methods
We retrospectively screened all acute PE patients from January 2010 to December 2019 in 5 university hospitals in Korea. We reviewed their medical records and clinical outcomes.
Results
During the study period, we screened total 3,572 patients with PE and found 33 high-risk PE patients with ECMO (17 women, 58.3±14.7 years old) whose data were analyzed. Common causes of acute PE included limited mobility (8, 24.2%), a recent operation (6, 18.2%) and a recent hospitalization for medical diseases (3, 9.1%). Among the patients, 25 (75.0%) had a history of cardiopulmonary resuscitation. Nineteen patients had received primary therapy (intravenous thrombolysis in 10, thrombectomy in 8 and catheter-based thrombolysis in 1). The mean duration of ECMO was 5.0 days (range, 1–23 days). The in-hospital mortality rate was 51.5%. Twenty-two patients (66.7%) had ECMO related complications (15 [46.9%] had bleeding, 10 [31.3%] had an infection, and 5 [15.6%] had vascular complications). Of 15 cases with bleeding, 13 of them had mild bleeding associated with catheter insertion, and 2 had moderate multiorgan bleeding.
Conclusions
ECMO can be used as an additional or alternative circulatory support method in high-risk PE patients. However, physicians should keep in mind a high incidence of complications related to ECMO.

Keyword

Shock; cardiogenic; Extracorporeal membrane oxygenation; Pulmonary embolism
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