Response letter: In patients with massive pulmonary embolism, we think a combination of VA-ECMO and other therapies should be studied

2021 ◽  
Author(s):  
Mina Karami ◽  
Loes Mandigers ◽  
Dinis Dos Reis Miranda ◽  
Wim J.R. Rietdijk ◽  
Jan M. Binnekade ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Va Ecmo

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.

Survival of intraoperative massive pulmonary embolism using alteplase and VA-ECMO

2019 ◽  
Vol 57 ◽  
pp. 112
Author(s):  
Monica I. Lupei ◽  
Benjamin Kloesel ◽  
Lida Trillos ◽  
Ioanna Apostolidou
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Va Ecmo

Successful use of extracorporeal membrane oxygenation in a child with obstructive shock due to massive bilateral pulmonary embolism

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 323-325 ◽  
Author(s):  
Aditya Badheka ◽  
Pradeep Bangalore Prakash ◽  
Veerajalandhar Allareddy
Keyword(s):  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Muscular Atrophy ◽  
Venous Malformation ◽  
Rare Condition ◽  
Massive Pulmonary Embolism ◽  
Spinal Muscular Atrophy Type ◽  
Membrane Oxygenation ◽  
Catheter Directed Thrombolysis ◽  
Va Ecmo

Background: Acute massive pulmonary embolism (PE) is a very rare condition in children. We report the successful use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a lifesaving modality in a child with acute massive PE. Case presentation: A nine-year-old female with spinal muscular atrophy type 1, chronic respiratory failure with tracheostomy and ventilator dependence presented with tachypnea and hypoxia. She had recent coiling of her pulmonary arterio-venous malformation. A chest computerized tomography scan showed massive bilateral PE. Urgent catheter-directed thrombolysis failed. She was placed on VA-ECMO with stabilization of hemodynamics. She underwent surgical thrombo-embolectomy followed by weaning of ECMO support. Discussion: The use of VA ECMO supported the cardio-respiratory status and perfusion to facilitate surgical embolectomy.

PREDICTORS OF RIGHT VENTRICULAR RECOVERY IN PATIENTS SUPPORTED WITH VA-ECMO FOR ACUTE MASSIVE PULMONARY EMBOLISM

2018 ◽  
Vol 71 (11) ◽  
pp. A1944
Author(s):  
Mehrdad Ghoreishi ◽  
Chetan Pasrija ◽  
Jean Jeudy ◽  
Frances Boulos ◽  
Kristopher Deatrick ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Massive Pulmonary Embolism ◽  
Va Ecmo

scholarly journals Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices

2020 ◽  
Vol 47 (3) ◽  
pp. 202-206
Author(s):  
Aneil Bhalla ◽  
Robert Attaran
Keyword(s):  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Massive Pulmonary Embolism ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Mechanical circulatory support may help patients with massive pulmonary embolism who are not candidates for systemic thrombolysis, pulmonary embolectomy, or catheter-directed therapy, or in whom these established interventions have failed. Little published literature covers this topic, which led us to compare outcomes of patients whose massive pulmonary embolism was managed with the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a right ventricular assist device (RVAD). We searched the medical literature from January 1990 through September 2018 for reports of adults hospitalized for massive or high-risk pulmonary embolism complicated by hemodynamic instability, and who underwent VA-ECMO therapy or RVAD placement. Primary outcomes included weaning from mechanical circulatory support and discharge from the hospital. We found 16 reports that included 181 patients (164 VA-ECMO and 17 RVAD). All RVAD recipients were successfully weaned from support, as were 122 (74%) of the VA-ECMO patients. Sixteen (94%) of the RVAD patients were discharged from the hospital, as were 120 (73%) of the VA-ECMO patients. Of note, the 8 RVAD patients who had an Impella RP System were all weaned and discharged. For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.

scholarly journals Massive Pulmonary Embolism with Hemodynamic Compromise Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation

2015 ◽  
Author(s):  
Bindu Akkanti ◽  
Sriram Nathan ◽  
E. Núñez Centeno ◽  
Karunakar Akasapu ◽  
Pratik Doshi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Pulmonary Embolus ◽  
Massive Pulmonary Embolism ◽  
Cognitive Status ◽  
Systemic Thrombolysis ◽  
Membrane Oxygenation ◽  
Successful Recovery ◽  
Va Ecmo

Introduction: Cardiogenic shock that results from pulmonary embolus has a high mortality rate. Systemic thrombolysis is frequently used in submassive and massive pulmonary embolus and has been shown to restore circulation. However, in the event of impending or ongoing cardiac arrest, systemic thrombolysis or anticoagulation alone has not been always shown to be effective. Case reports have previously established that extracorporeal membrane oxygenation can effectively be used as an effective rescue strategy in cases of cardiac arrest as a result from massive pulmonary embolus. We report six cases of massive pulmonary embolism (PE), in which veno-arterial extracorporeal membrane oxygenation (VA ECMO) was utilized or used as a backup strategy with excellent outcomes. We highly recommend using this strategy at the bedside in a tertiary care facility where VA ECMO support is available. Methods: This is a retrospective study of all patients that underwent VA ECMO or utilized VA ECMO at the bedside as a rescue strategy in the setting of massive PE. We abstracted relevant clinical information from patient charts for this review. Results and analysis: Out of the 107 VA ECMO runs performed at our facility between 1 September 2013 and 31 December 2014, four patients utilized this strategy in the setting of massive PE with impending cardiac arrest; in two cases it was available to use as a backup strategy. All six patients (Table 1) had successful recovery with complete restoration of cognitive status, functional status, and without any clinical signs of right ventricular (RV) dysfunction on discharge.

scholarly journals Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

2021 ◽  
Vol 10 (15) ◽  
pp. 3376
Author(s):  
Raphaël Giraud ◽  
Matthieu Laurencet ◽  
Benjamin Assouline ◽  
Amandine De Charrière ◽  
Carlo Banfi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Study ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Massive Pulmonary Embolism ◽  
Bleeding Complications ◽  
Circulatory Support ◽  
Adequate Treatment ◽  
Number Of Patients ◽  
Va Ecmo

Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65–91.57, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, p = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.

Abstract #860 Massive Pulmonary Embolism as the First Presentation of a Patient with Acromegaly

2018 ◽  
Vol 24 ◽  
pp. 204-205
Author(s):  
Wajiha Gul ◽  
Mehdi Errayes ◽  
Buthaina Alowainati
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism
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