Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

Article Article scientifique Article Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? eng 2021-07-30 2021-08 author Giraud Raphaël 0000-0001-5956-8643 639599 author Laurencet Matthieu 778855 author Assouline Benjamin 595385 author de Charrière Amandine Solange Marie 935964 author Banfi Carlo 798435 author Bendjelid Karim 0000-0002-7921-7207 527948 3376 10.3390/jcm10153376 34362159 2077-0383 PMC8348430 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, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, p = 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. VA-ECMO Cardiogenic shock Massive acute pulmonary embolism Thrombolysis Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 570 Groupe de recherche en hémodynamique 913 Journal of clinical medicine 10 15 e6484252-a2a2-41f0-b020-e351f6ff8e30 Article (Published version) Public Article-scientifique-from-europePmc.pdf 581160 application/pdf CC BY-4.0 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?	Journal of clinical medicine			2021	295	206

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Laurencet, Matthieu