Cargando…

Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?

Pulmonary embolism (PE) is a common disease with an annual incidence rate ranging from 39–115 per 100,000 inhabitants. It is one of the leading causes of cardiovascular mortality in the USA and Europe. While the clinical presentation and severity may vary, it is a life-threatening condition in its m...

Descripción completa

Detalles Bibliográficos
Autores principales: Assouline, Benjamin, Assouline-Reinmann, Marie, Giraud, Raphaël, Levy, David, Saura, Ouriel, Bendjelid, Karim, Combes, Alain, Schmidt, Matthieu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409813/
https://www.ncbi.nlm.nih.gov/pubmed/36012973
http://dx.doi.org/10.3390/jcm11164734
_version_ 1784774942634541056
author Assouline, Benjamin
Assouline-Reinmann, Marie
Giraud, Raphaël
Levy, David
Saura, Ouriel
Bendjelid, Karim
Combes, Alain
Schmidt, Matthieu
author_facet Assouline, Benjamin
Assouline-Reinmann, Marie
Giraud, Raphaël
Levy, David
Saura, Ouriel
Bendjelid, Karim
Combes, Alain
Schmidt, Matthieu
author_sort Assouline, Benjamin
collection PubMed
description Pulmonary embolism (PE) is a common disease with an annual incidence rate ranging from 39–115 per 100,000 inhabitants. It is one of the leading causes of cardiovascular mortality in the USA and Europe. While the clinical presentation and severity may vary, it is a life-threatening condition in its most severe form, defined as high-risk or massive PE. Therapeutic options in high-risk PE are limited. Current guidelines recommend the use of systemic thrombolytic therapy as first-line therapy (Level Ib). However, this treatment has important drawbacks including bleeding complications, limited efficacy in patients with recurrent PE or cardiac arrest, and formal contraindications. In this context, the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the management of high-risk PE has increased worldwide in the last decade. Strategies, including VA-ECMO as a stand-alone therapy or as a bridge to alternative reperfusion therapies, are associated with acceptable outcomes, especially if implemented before cardiac arrest. Nonetheless, the level of evidence supporting ECMO and alternative reperfusion therapies is low. The optimal management of high-risk PE patients will remain controversial until the realization of a prospective randomized trial comparing those cited strategies to systemic thrombolysis.
format Online
Article
Text
id pubmed-9409813
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-94098132022-08-26 Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation? Assouline, Benjamin Assouline-Reinmann, Marie Giraud, Raphaël Levy, David Saura, Ouriel Bendjelid, Karim Combes, Alain Schmidt, Matthieu J Clin Med Review Pulmonary embolism (PE) is a common disease with an annual incidence rate ranging from 39–115 per 100,000 inhabitants. It is one of the leading causes of cardiovascular mortality in the USA and Europe. While the clinical presentation and severity may vary, it is a life-threatening condition in its most severe form, defined as high-risk or massive PE. Therapeutic options in high-risk PE are limited. Current guidelines recommend the use of systemic thrombolytic therapy as first-line therapy (Level Ib). However, this treatment has important drawbacks including bleeding complications, limited efficacy in patients with recurrent PE or cardiac arrest, and formal contraindications. In this context, the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the management of high-risk PE has increased worldwide in the last decade. Strategies, including VA-ECMO as a stand-alone therapy or as a bridge to alternative reperfusion therapies, are associated with acceptable outcomes, especially if implemented before cardiac arrest. Nonetheless, the level of evidence supporting ECMO and alternative reperfusion therapies is low. The optimal management of high-risk PE patients will remain controversial until the realization of a prospective randomized trial comparing those cited strategies to systemic thrombolysis. MDPI 2022-08-13 /pmc/articles/PMC9409813/ /pubmed/36012973 http://dx.doi.org/10.3390/jcm11164734 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Assouline, Benjamin
Assouline-Reinmann, Marie
Giraud, Raphaël
Levy, David
Saura, Ouriel
Bendjelid, Karim
Combes, Alain
Schmidt, Matthieu
Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title_full Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title_fullStr Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title_full_unstemmed Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title_short Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
title_sort management of high-risk pulmonary embolism: what is the place of extracorporeal membrane oxygenation?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409813/
https://www.ncbi.nlm.nih.gov/pubmed/36012973
http://dx.doi.org/10.3390/jcm11164734
work_keys_str_mv AT assoulinebenjamin managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT assoulinereinmannmarie managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT giraudraphael managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT levydavid managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT sauraouriel managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT bendjelidkarim managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT combesalain managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation
AT schmidtmatthieu managementofhighriskpulmonaryembolismwhatistheplaceofextracorporealmembraneoxygenation