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Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2022, v.85 no.3, pp.249-255
https://doi.org/10.4046/trd.2022.0004
Bo Young Lee (Soonchunhyang University College of Medicine)
Jang Joonyong (Department of Internal Medicine)
Kim Ki-Up (Soonchunhyang University College of Medicine)
Kim Yang-Ki (Soonchunhyang University College of Medicine)
Uh Soo-Taek
Jang Gae-Eil (Department of Internal Medicine)
Wonho Chang (Soonchunhyang University College of Medicine)
구소미 (순천향대학교)
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Abstract

Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO.Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed.Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22–76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2–14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30–32 minutes) in survivors (n=2) and 65 minutes (range, 33–482 minutes) in non-survivors (n=7).Conclusion: High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

keywords
Pulmonary Embolism, Extracorporeal Membrane Oxygenation, Cardiac Ar, rest

Tuberculosis & Respiratory Diseases