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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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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 |
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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 |
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