PMID- 35722115
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 9
DP  - 2022
TI  - Extracorporeal Membrane Oxygenation-First Strategy for Acute Life-Threatening 
      Pulmonary Embolism.
PG  - 875021
LID - 10.3389/fcvm.2022.875021 [doi]
LID - 875021
AB  - BACKGROUND: Both venoarterial extracorporeal membrane oxygenation (VA-ECMO) and 
      percutaneous mechanical thrombectomy (PMT) are increasingly used to treat acute 
      life-threatening pulmonary embolism (PE). However, there are little data 
      regarding their effectiveness. This study aimed to present the short-term 
      outcomes after managing nine patients with acute life-threatening massive or 
      submassive PE by VA-ECMO with or without complemented PMT and propose a 
      preliminary treatment algorithm. METHODS: This study was a single-center 
      retrospective review of a prospectively maintained registry. It included nine 
      consecutive patients with massive or submassive pulmonary embolism who underwent 
      VA-ECMO for initial hemodynamic stabilization, with or without PMT, from August 
      2018 to November 2021. RESULTS: Mean patient age was 54.7 years. Four of nine 
      patients (44.4%) required cardiopulmonary resuscitation before or during VA-ECMO 
      cannulation. All cannulations (100%) were successfully performed percutaneously. 
      Overall survival was 88.9% (8 of 9 patients). One patient died from a hemorrhagic 
      stroke. Of the survivors, the median ECMO duration was 8 days in patients treated 
      with ECMO alone and 4 days in those treated with EMCO and PMT. Five of nine 
      patients (55.6%) required concomitant PMT to address persistent right heart 
      dysfunction, with the remaining survivors (44.4%) receiving VA-ECMO and 
      anticoagulation alone. For survivors receiving VA-ECMO plus PMT, median hospital 
      lengths of stay were 7 and 13 days, respectively. CONCLUSIONS: An ECMO-first 
      strategy complemented with PMT can be performed effectively and safely for acute 
      life-threatening massive or submassive PE. VA-ECMO is feasible for initial 
      stabilization, serving as a bridge to therapy primarily in inoperable patients 
      with massive PE. Further evaluation in a larger cohort of patients is warranted 
      to assess whether VA-ECMO plus PMT may offer an alternative or complementary 
      therapy to thrombolysis or surgical thrombectomy. TYPE OF RESEARCH: Single-center 
      retrospective review of a prospectively maintained registry.
CI  - Copyright (c) 2022 Liu, Chen, Xu, Lan, He, Shao, Xu, Han, Chen, Zhu and Huang.
FAU - Liu, Zhenjie
AU  - Liu Z
AD  - Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - Chen, Jinyi
AU  - Chen J
AD  - Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - Xu, Xin
AU  - Xu X
AD  - Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Lan, Fen
AU  - Lan F
AD  - Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - He, Minzhi
AU  - He M
AD  - Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - Shao, Changming
AU  - Shao C
AD  - Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - Xu, Yongshan
AU  - Xu Y
AD  - Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Han, Pan
AU  - Han P
AD  - Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Chen, Yibing
AU  - Chen Y
AD  - Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Zhu, Yongbin
AU  - Zhu Y
AD  - Medical Department, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Huang, Man
AU  - Huang M
AD  - Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School 
      of Medicine, Hangzhou, China.
LA  - eng
PT  - Journal Article
DEP - 20220603
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC9203845
OTO - NOTNLM
OT  - outcome
OT  - percutaneous mechanical thrombectomy
OT  - pulmonary embolism
OT  - treatment
OT  - venoarterial extracorporeal membrane oxygenation
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/06/21 06:00
MHDA- 2022/06/21 06:01
PMCR- 2022/01/01
CRDT- 2022/06/20 04:04
PHST- 2022/02/13 00:00 [received]
PHST- 2022/05/09 00:00 [accepted]
PHST- 2022/06/20 04:04 [entrez]
PHST- 2022/06/21 06:00 [pubmed]
PHST- 2022/06/21 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2022.875021 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2022 Jun 3;9:875021. doi: 10.3389/fcvm.2022.875021. 
      eCollection 2022.