scholarly journals Use of mechanical pulmonary reperfusion and fibrinolysis in acute massive pulmonary embolism requiring extracorporeal membrane oxygenation support: A systematic review and meta-analysis

2022 ◽  
Vol 14 (1) ◽  
pp. 90
Author(s):  
R. Chopard ◽  
P. Nielsen ◽  
F. Ius ◽  
H. Pilichowski ◽  
N. Meneveau
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Meta Analysis ◽  
Massive Pulmonary Embolism ◽  
Membrane Oxygenation

scholarly journals Use of mechanical pulmonary reperfusion and fibrinolysis in acute massive pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Chopard ◽  
P Nielsen ◽  
F Ius ◽  
H Pilichowski ◽  
N Meneveau
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Reperfusion Therapy ◽  
Massive Pulmonary Embolism ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Surgical Embolectomy ◽  
Meta Regression ◽  
Va Ecmo

Abstract Background and objectives The optimal pulmonary revascularization strategy in acute massive pulmonary embolism (PE) requiring the implantation extra corporeal membrane oxygenation remains controversial, and data are sparse. Methods We conducted a systematic review and meta-analysis of available evidence regarding the use of mechanical reperfusion (i.e. surgical or catheter-based embolectomy) and fibrinolytic strategies (i.e. systemic fibrinolysis, catheter-directed fibrinolysis, or as stand-alone therapy) in terms of mortality and bleeding outcomes. Results The literature search identified 835 studies, 17 of which were included or a total of 321 PE patients with ECMO. In total, 31.1% were treated with mechanical pulmonary reperfusion, while 78.9% received fibrinolytic strategies. The mortality rate was 23.0% in the mechanical reperfusion group and 43.1% in the fibrinolysis group (Figure). The pooled OR for mortality with mechanical reperfusion was 0.46 (95% CI, 0.213–0.997; I2=28.3%) versus fibrinolysis. The rate of bleeding in PE patients under ECMO was 29.1% in the mechanical reperfusion group and 26.0% in the fibrinolytic reperfusion (OR, 1.09; 95% CI, 0.46–2.54; I2=0.0%) among 10 eligible studies with available bleeding data. The meta-regression model did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy” and “ECMO implantation before pulmonary reperfusion therapy”, and outcomes. Conclusions The results of the present meta-analysis and meta-regression suggest that surgical embolectomy yields the best results, regardless of the timing of VA-ECMO implantation in the reperfusion timeline, and regardless of whether fibrinolysis has been administered or not. FUNDunding Acknowledgement Type of funding sources: None.

Extracorporeal Membrane Oxygenation

2019 ◽  
pp. 152-158
Author(s):  
J. Kyle Bohman ◽  
Gregory J. Schears
Keyword(s):  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Bridge To Transplant ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Improved Outcomes ◽  
Resource Requirements ◽  
Substantial Resource

This chapter examines the indications, applications, and complications of modern extracorporeal membrane oxygenation (ECMO). The safety profile of ECMO has improved through advancements in devices, components, and routine management, resulting in improved outcomes and an expanded range of applications. Currently, ECMO can provide cardiopulmonary support in reversible conditions, such as post-cardiotomy shock, acute respiratory failure, extracorporeal cardiopulmonary resuscitation, bridge to transplant, complex airway repairs, and massive pulmonary embolism, among others. The chapter focuses on the primary factors involved in using ECMO successfully: appropriate patient selection, optimal cannulation strategy, and availability of comprehensive medical resources (or a referral agreement with a comprehensive ECMO center) to handle emergent ECMO complications and to absorb the substantial resource requirements of treating patients with ECMO.

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