Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study

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发表日期：

2024年6月24日

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David Levy,
Ouriel Saura,
Maria Teresa Passarelli,
Manuela Lucenteforte,
Guillaume Lebreton,
Adrien Bougle,
Antoine Monsel,
Sofia Ortuno,
Yoël Benitha,
Nadjib Hammoudi,
Benjamin Assouline,
Matthieu Petit,
Melchior Gautier,
Lucie Le Fevre,
Marc Pineton de Chambrun,
Charles Juvin,
Juliette Chommeloux,
Charles-Edouard Luyt,
Guillaume Hékimian,
Pascal Leprince,
Alain Combes,
Matthieu Schmidt

摘要

Purpose

Despite systemic thrombolysis, a few patients with high-risk pulmonary embolism (PE) remain hemodynamically unstable. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a considerable lifesaving therapy but systemic thrombolysis before cannulation could carry a high risk of hemorrhage and alter the prognosis.

Methods

Between June 2012 and June 2023, we retrospectively analyzed from three intensive care units in Sorbonne University, ECMO-related complications and 90-day mortality for high-risk PE patients who received ECMO without previous systemic thrombolysis compared to those cannulated after systemic thrombolysis failure. Hospital discharge survivors were assessed for long-term health-related quality of life and echocardiographic evaluations.

Results

72 high-risk PE patients [median age 48 (37–61) years, Simplified Acute Physiology Score II (SAPS II) 74 (60–85)] were placed on VA-ECMO for 5 (5–7) days. 31 (43%) patients underwent pre-ECMO thrombolysis (thrombolysis ECMO group, T +) compared to 41 patients (57%, no thrombolysis ECMO group, T−). There was more pre-ECMO cardiac arrest in the thrombolysis ECMO group (94% vs. 67%, p = 0.02). Ninety-day survival was not different between groups (39% vs 46%, log-rank test, p = 0.31). There was no difference in severe hemorrhages (61% vs 59%, p = 1). Twenty-five over 28 patients attended follow-up at a median time of 69 (52–95) months. Long-term quality of life was acceptable and none of them experienced chronic thromboembolic pulmonary hypertension.

Conclusions

Ninety-day survival and bleeding events rates did not differ in patients treated with VA-ECMO after systemic thrombolysis compared to those who were not. Recent systemic thrombolysis, as a single parameter, should not be considered as a contraindication for VA-ECMO in high-risk PE.