PMID- 34049258
OWN - NLM
STAT- MEDLINE
DCOM- 20211018
LR  - 20220302
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Linking)
VI  - 64
DP  - 2021 Aug
TI  - Survival of patients with acute pulmonary embolism treated with venoarterial 
      extracorporeal membrane oxygenation: A systematic review and meta-analysis.
PG  - 245-254
LID - S0883-9441(21)00053-8 [pii]
LID - 10.1016/j.jcrc.2021.03.006 [doi]
AB  - BACKGROUND: To examine whether venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) improves survival of patients with acute pulmonary embolism (PE). 
      METHODS: Following the PRISMA guidelines, a systematic search was conducted up to 
      August 2019 of the databases: PubMed/MEDLINE, EMBASE and Cochrane. All studies 
      reporting the survival of adult patients with acute PE treated with VA-ECMO and 
      including four patients or more were included. Exclusion criteria were: 
      correspondences, reviews and studies in absence of a full text, written in other 
      languages than English or Dutch, or dating before 1980. Short-term (hospital or 
      30-day) survival data were pooled and presented with relative risks (RR) and 95% 
      confidence intervals (95% CI). Also, the following pre-defined factors were 
      evaluated for their association with survival in VA-ECMO treated patients: age > 
      60 years, male sex, pre-ECMO cardiac arrest, surgical embolectomy, catheter 
      directed therapy, systemic thrombolysis, and VA-ECMO as single therapy. RESULTS: 
      A total of 29 observational studies were included (N = 1947 patients: VA-ECMO N = 
      1138 and control N = 809). There was no difference in short-term survival between 
      VA-ECMO treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In 
      acute PE patients undergoing VA-ECMO, age > 60 years was associated with lower 
      survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was associated with 
      higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO cardiac arrest showed a 
      trend toward lower survival (RR 0.88, 95% CI 0.77-1.01). The other evaluated 
      factors were not associated with a difference in survival. CONCLUSIONS: At 
      present, there is insufficient evidence that VA-ECMO treatment improves 
      short-term survival of acute PE patients. Low quality evidence suggest that 
      VA-ECMO patients aged </=60 years or who received SE have higher survival rates. 
      Considering the limited evidence derived from the present data, this study 
      emphasizes the need for prospective studies. PROTOCOL REGISTRATION: PROSPERO 
      CRD42019120370.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Karami, Mina
AU  - Karami M
AD  - Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, 
      Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Mandigers, Loes
AU  - Mandigers L
AD  - Department of Intensive Care Medicine, Erasmus University Medical Center, 
      Rotterdam, the Netherlands.
FAU - Miranda, Dinis Dos Reis
AU  - Miranda DDR
AD  - Department of Intensive Care Medicine, Erasmus University Medical Center, 
      Rotterdam, the Netherlands.
FAU - Rietdijk, Wim J R
AU  - Rietdijk WJR
AD  - Department of Intensive Care Medicine, Erasmus University Medical Center, 
      Rotterdam, the Netherlands.
FAU - Binnekade, Jan M
AU  - Binnekade JM
AD  - Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 
      Amsterdam, the Netherlands.
FAU - Knijn, Danielle C M
AU  - Knijn DCM
AD  - Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 
      Amsterdam, the Netherlands.
FAU - Lagrand, Wim K
AU  - Lagrand WK
AD  - Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 
      Amsterdam, the Netherlands.
FAU - den Uil, Corstiaan A
AU  - den Uil CA
AD  - Department of Intensive Care Medicine, Erasmus University Medical Center, 
      Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical 
      Center, Rotterdam, the Netherlands.
FAU - Henriques, Jose P S
AU  - Henriques JPS
AD  - Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, 
      Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Vlaar, Alexander P J
AU  - Vlaar APJ
AD  - Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 
      Amsterdam, the Netherlands. Electronic address: a.p.vlaar@amsterdamumc.nl.
CN  - DUTCH ECLS Study Group
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210324
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
SB  - IM
CIN - J Crit Care. 2022 Feb;67:223-224. PMID: 34782186
CIN - J Crit Care. 2022 Feb;67:225-226. PMID: 34794835
MH  - Acute Disease
MH  - Adult
MH  - *Extracorporeal Membrane Oxygenation
MH  - *Heart Arrest/therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - *Pulmonary Embolism/therapy
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Cardiac arrest
OT  - ECPR
OT  - Extracorporeal life support
OT  - Extracorporeal membrane oxygenation
OT  - Hemodynamic instability
OT  - Pulmonary embolism
COIS- Declaration of Competing Interest The authors declare that they have no competing 
      interest.
EDAT- 2021/05/29 06:00
MHDA- 2021/10/21 06:00
CRDT- 2021/05/28 20:29
PHST- 2020/06/10 00:00 [received]
PHST- 2020/12/21 00:00 [revised]
PHST- 2021/03/14 00:00 [accepted]
PHST- 2021/05/29 06:00 [pubmed]
PHST- 2021/10/21 06:00 [medline]
PHST- 2021/05/28 20:29 [entrez]
AID - S0883-9441(21)00053-8 [pii]
AID - 10.1016/j.jcrc.2021.03.006 [doi]
PST - ppublish
SO  - J Crit Care. 2021 Aug;64:245-254. doi: 10.1016/j.jcrc.2021.03.006. Epub 2021 Mar 
      24.