Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?
Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, althou...
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| Format: | Article |
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MDPI AG
2021-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/15/3376 |
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| author | Raphaël Giraud Matthieu Laurencet Benjamin Assouline Amandine De Charrière Carlo Banfi Karim Bendjelid |
| author_facet | Raphaël Giraud Matthieu Laurencet Benjamin Assouline Amandine De Charrière Carlo Banfi Karim Bendjelid |
| author_sort | Raphaël Giraud |
| collection | DOAJ |
| description | Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65–91.57, <i>p</i> = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, <i>p</i> < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, <i>p</i> = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients. |
| first_indexed | 2024-03-10T09:12:43Z |
| format | Article |
| id | doaj.art-1afe1fdcf8894103b332c021ad7aed6a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T09:12:43Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1afe1fdcf8894103b332c021ad7aed6a2023-11-22T05:49:52ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-011015337610.3390/jcm10153376Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?Raphaël Giraud0Matthieu Laurencet1Benjamin Assouline2Amandine De Charrière3Carlo Banfi4Karim Bendjelid5Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, SwitzerlandIntensive Care Unit, Geneva University Hospitals, 1205 Geneva, SwitzerlandIntensive Care Unit, Geneva University Hospitals, 1205 Geneva, SwitzerlandIntensive Care Unit, Geneva University Hospitals, 1205 Geneva, SwitzerlandGeneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, SwitzerlandIntensive Care Unit, Geneva University Hospitals, 1205 Geneva, SwitzerlandIntroduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65–91.57, <i>p</i> = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, <i>p</i> < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, <i>p</i> = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.https://www.mdpi.com/2077-0383/10/15/3376massive acute pulmonary embolismcardiogenic shockVA-ECMOthrombolysis |
| spellingShingle | Raphaël Giraud Matthieu Laurencet Benjamin Assouline Amandine De Charrière Carlo Banfi Karim Bendjelid Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? Journal of Clinical Medicine massive acute pulmonary embolism cardiogenic shock VA-ECMO thrombolysis |
| title | Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? |
| title_full | Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? |
| title_fullStr | Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? |
| title_full_unstemmed | Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? |
| title_short | Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? |
| title_sort | can va ecmo be used as an adequate treatment in massive pulmonary embolism |
| topic | massive acute pulmonary embolism cardiogenic shock VA-ECMO thrombolysis |
| url | https://www.mdpi.com/2077-0383/10/15/3376 |
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