Extracorporeal membrane oxygenation and reperfusion strategies in high-risk pulmonary embolism hospitalizations

• Verfasst von: Farmakis, Ioannis T. [VerfasserIn]
• Verfasst von: Sagoschen, Ingo [VerfasserIn]
• Verfasst von: Barco, Stefano [VerfasserIn]
• Verfasst von: Keller, Karsten [VerfasserIn]
• Verfasst von: Valerio, Luca [VerfasserIn]
• Verfasst von: Wild, Johannes [VerfasserIn]
• Verfasst von: Giannakoulas, George [VerfasserIn]
• Verfasst von: Piazza, Gregory [VerfasserIn]
• Verfasst von: Konstantinides, Stavros [VerfasserIn]
• Verfasst von: Hobohm, Lukas [VerfasserIn]
• Titel: Extracorporeal membrane oxygenation and reperfusion strategies in high-risk pulmonary embolism hospitalizations
• Verf.angabe: Ioannis T. Farmakis, MD, Ingo Sagoschen, MD, Stefano Barco, MD, Karsten Keller, MD, Luca Valerio, MD, Johannes Wild, MD, George Giannakoulas, MD, Gregory Piazza, MD, Stavros V. Konstantinides, MD, Lukas Hobohm, MD
• E-Jahr: 2024
• Jahr: October 2024
• Umfang: 10 S.
• Fussnoten: Gesehen am 10.04.2025
• Titel Quelle: Enthalten in: Critical care medicine
• Ort Quelle: Hagerstown, Md. : Lippincott Williams & Wilkins, 1973
• Jahr Quelle: 2024
• Band/Heft Quelle: 52(2024), 10 vom: Okt., Seite e512-e521
• ISSN Quelle: 1530-0293
• DOI: doi:10.1097/CCM.0000000000006361
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1922077623

Abstract

OBJECTIVES: - To investigate the contemporary use of extracorporeal membrane oxygenation (ECMO) in conjunction with reperfusion strategies in high-risk pulmonary embolism (PE). - DESIGN: - Observational epidemiological analysis. - SETTING: - The U.S. Nationwide Inpatient Sample (NIS) (years 2016-2020). - PATIENTS: - High-risk PE hospitalizations. - MEASUREMENTS AND MAIN RESULTS: - Use of ECMO in conjunction with thrombolysis-based reperfusion (systemic thrombolysis or catheter-directed thrombolysis) or mechanical reperfusion (surgical embolectomy or catheter-based thrombectomy) with regards to in-hospital mortality and major bleeding. We identified high-risk PE hospitalizations in the NIS (years 2016-2020) and investigated the use of ECMO in conjunction with thrombolysis-based (systemic thrombolysis or catheter-directed thrombolysis) and mechanical (surgical embolectomy or catheter-based thrombectomy) reperfusion strategies with regards to in-hospital mortality and major bleeding. Among 122,735 hospitalizations for high-risk PE, ECMO was used in 2,805 (2.3%); stand-alone in 1.4%, thrombolysis-based reperfusion in 0.4%, and mechanical reperfusion in 0.5%. Compared with neither reperfusion nor ECMO, ECMO plus thrombolysis-based reperfusion was associated with reduced in-hospital mortality (adjusted odds ratio [aOR] 0.61; 95% CI, 0.38-0.98), whereas no difference was found with ECMO plus mechanical reperfusion (aOR 1.03; 95% CI, 0.67-1.60), and ECMO stand-alone was associated with increased in-hospital mortality (aOR 1.60; 95% CI, 1.22-2.10). In the cardiac arrest subgroup, ECMO was associated with reduced in-hospital mortality (aOR 0.71; 95% CI, 0.53-0.93). Among all patients on ECMO, thrombolysis-based reperfusion was significantly associated (aOR 0.55; 95% CI, 0.33-0.91), and mechanical reperfusion showed a trend (aOR 0.75; 95% CI, 0.47-1.19) toward reduced in-hospital mortality compared with no reperfusion, without increases in major bleeding. - CONCLUSIONS: - In patients with high-risk PE and refractory hemodynamic instability, ECMO may be a valuable supportive treatment in conjunction with reperfusion treatment but not as a stand-alone treatment especially for patients suffering from cardiac arrest.