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2017 ; 21
(1
): 76
Nephropedia Template TP
gab.com Text
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Life-threatening massive pulmonary embolism rescued by
venoarterial-extracorporeal membrane oxygenation
#MMPMID28347320
Corsi F
; Lebreton G
; Bréchot N
; Hekimian G
; Nieszkowska A
; Trouillet JL
; Luyt CE
; Leprince P
; Chastre J
; Combes A
; Schmidt M
Crit Care
2017[Mar]; 21
(1
): 76
PMID28347320
show ga
BACKGROUND: Despite quick implementation of reperfusion therapies, a few patients
with high-risk, acute, massive, pulmonary embolism (PE) remain highly
hemodynamically unstable. Others have absolute contraindication to receive
reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO)
might lower their right ventricular overload, improve hemodynamic status, and
restore tissue oxygenation. METHODS: ECMO-related complications and 90-day
mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients
admitted to a tertiary-care center (2006-2015). Hospital- discharge survivors
were assessed for long-term health-related quality of life. A systematic review
of this topic was also conducted. RESULTS: Seventeen high-risk PE patients
[median age 51 (range 18-70) years, Simplified Acute Physiology Score II (SAPS
II) 78 (45-95)] were placed on VA-ECMO for 4 (1-12) days. Among 15 (82%) patients
with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary
resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median
blood pressure, pH, and blood lactate were, respectively: 42 (0-106) mmHg, 6.99
(6.54-7.37) and 13 (4-19) mmol/L. Ninety-day survival was 47%. Fifteen (88%)
patients suffered in-ICU severe hemorrhages with no impact on survival. Like
other ECMO-treated patients, ours reported limitations of all physical domains
but preserved mental health 19 (4-69) months post-ICU discharge. CONCLUSIONS:
VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute,
massive PE when thrombolytic therapy fails or the patient is too sick to benefit
from surgical thrombectomy. Because heparin-induced clot dissolution and
spontaneous fibrinolysis allows ECMO weaning within several days, future studies
should investigate whether VA-ECMO should be the sole therapy or completed by
additional mechanical clot-removal therapies in this setting.
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Extracorporeal Membrane Oxygenation/*methods/mortality/statistics & numerical
data
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Intensive Care Units/organization & administration/statistics & numerical data
[MESH]
free
free
free
