Extracorporeal membrane oxygenation improved survival in patients with massive pulmonary embolism

BACKGROUND: Current guidelines for massive pulmonary embolism (PE) treatment recommend primary reperfusion therapy and the option of extracorporeal membrane oxygenation (ECMO). However, these recommendations might not be optimal for patients with poor prognoses who are in cardiogenic shock (CS) or require cardiopulmonary resuscitation (CPR). OBJECTIVE: Evaluate the impact of ECMO support on the clinical outcome of patients with massive PE complicated by CPR or CS. DESIGN: Retrospective review of medical records. SETTING: A university hospital, South Korea. PATIENTS AND METHODS: We collected data on patients from 2004 through 2009 (stage 1) and from 2010 through June 2017 (stage 2). Patients with confirmed massive PE received medical therapy (stage 1) or medical therapy that included extracorporeal membrane oxygenation (ECMO) support (stage 2). MAIN OUTCOME MEASURES: All-cause mortality at 90 days after therapy. SAMPLE SIZE: 9 patients with confirmed massive PE that received medical therapy (stage 1); 14 patients with confirmed massive PE that received medical therapy with ECMO support (stage 2). RESULTS: In stage 1, 5 of 9 patients received systemic thrombolysis and 4 patients received anticoagulation. Thirteen of the 14 stage 2 patients received anticoagulation with ECMO support and one patient received systemic thrombolysis with ECMO support. Tricuspid annular plane systolic excursion in stage 1 was lower than in stage 2. Proximal PE in chest CT was more common in stage 2. Survival was significantly improved at 90 days for patients in stage 2 (log-rank, P=.048). There were no differences in baseline characteristics, ECMO complications and transfusion between survivors and nonsurvivors in stage 2. CONCLUSIONS: Anticoagulation with ECMO support is associated with good survival rate outcomes compared with medical therapy alone. LIMITATIONS: Relatively small number of patients and retrospective design.