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Research article
Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases
Yen-Yu Chen
Chang Gung Memorial Hospital Kaohsiung Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2065-5568
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Journal of Cardiothoracic Surgery.
Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE.
Methods: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated.
Results: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001).
Conclusions: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.
Keywords
acute pulmonary embolism, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, cardiac arrest
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CURRENT STATUS: Published
Version 2
Posted 25 Sep, 2020
Published
On 02 Oct, 2020
No community comments so far
Editorial decision: Accept
On 27 Sep, 2020
Editor assigned
On 23 Sep, 2020
Submission checks complete
On 22 Sep, 2020
Editor invited
On 22 Sep, 2020
No comments provided
Editorial decision: Major revision
On 31 Aug, 2020
Review #2 received
Received 09 Jul, 2020
Review #1 received
Received 07 Jul, 2020
Reviewer #2 agreed
On 25 Jun, 2020
Reviewer #1 agreed
On 21 Jun, 2020
Reviewers invited
Invitations sent on 20 Jun, 2020
First submitted
On 17 Jun, 2020
Editor assigned
On 17 Jun, 2020
Submission checks complete
On 16 Jun, 2020
Editor invited
On 16 Jun, 2020
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Subject Areas
Cardiothoracic Surgery
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This preprint is under consideration at Journal of Cardiothoracic Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases
Yen-Yu Chen
Chang Gung Memorial Hospital Kaohsiung Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2065-5568
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 25 Sep, 2020
Published
On 02 Oct, 2020
No community comments so far
Editorial decision: Accept
On 27 Sep, 2020
Editor assigned
On 23 Sep, 2020
Submission checks complete
On 22 Sep, 2020
Editor invited
On 22 Sep, 2020
No comments provided
Editorial decision: Major revision
On 31 Aug, 2020
Review #2 received
Received 09 Jul, 2020
Review #1 received
Received 07 Jul, 2020
Reviewer #2 agreed
On 25 Jun, 2020
Reviewer #1 agreed
On 21 Jun, 2020
Reviewers invited
Invitations sent on 20 Jun, 2020
First submitted
On 17 Jun, 2020
Editor assigned
On 17 Jun, 2020
Submission checks complete
On 16 Jun, 2020
Editor invited
On 16 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiothoracic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Journal of Cardiothoracic Surgery.
Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE.
Methods: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated.
Results: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001).
Conclusions: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.