Aim

of the study: Extracorporeal membrane oxygenation (ECMO) is considered a life-saving treatment option for patients in cardiogenic shock or cardiac arrest undergoing cardiopulmonary resuscitation (CPR) due to acute pulmonary embolism (PE). We sought to analyze use and outcome of ECMO with or without adjunctive treatment strategies in patients with acute PE.

Methods

We retrospectively analyzed data on patient characteristics, treatments, and in-hospital outcomes for all PE patients (ICD-code I26) undergoing ECMO in Germany between 2005 and 2018.

Results

At total of 1,172,354 patients were hospitalized with PE; of those, 2,197 (0.2%) were treated with ECMO support. Cardiac arrest requiring cardiopulmonary resuscitation was present in 77,196 (6.5%) patients. While more than one fourth of those patients were treated with systemic thrombolysis alone (n=20,839 patients; 27.0%), a minority of patients received thrombolysis and VA-ECMO (n=165; 0.2%), embolectomy and VA-ECMO (n=385; 0.5%) or VA-ECMOalone (n=588; 0.8%). A multivariable logistic regression analysis indicated the lowest risk for in-hospital death in patients who received embolectomy in combination with VA-ECMO (OR, 0.50 [95%CI, 0.41-0.61], P<0.001), thrombolysis and VA-ECMO (0.60 [0.43-0.85], P=0.003) or VA-ECMO alone (0.68 [0.57-0.82], P<0.001) compared to thrombolysis alone (1.04 [0.99-1.01], P=0.116).

Conclusion

Our findings suggest that the use of VA-ECMO alone or as part of a multi-pronged reperfusion approach including embolectomy or thrombolysis might offer survival advantages compared to thrombolysis alone in patients with PE deteriorating to cardiac arrest.

中文翻译：

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肺栓塞患者体外膜氧合的临床应用和结果

目的

研究内容：体外膜肺氧合 (ECMO) 被认为是心源性休克或心脏骤停患者因急性肺栓塞 (PE) 接受心肺复苏 (CPR) 的一种挽救生命的治疗选择。我们试图分析 ECMO 在有或没有辅助治疗策略的情况下在急性 PE 患者中的使用和结果。

方法

我们回顾性分析了 2005 年至 2018 年间在德国接受 ECMO 的所有 PE 患者（ICD 代码 I26）的患者特征、治疗和住院结局的数据。

结果

共有 1,172,354 名患者因 PE 住院；其中，2,197 人（0.2%）接受了 ECMO 支持治疗。77,196 (6.5%) 名患者出现需要心肺复苏的心脏骤停。虽然超过四分之一的患者仅接受全身溶栓治疗（n=20,839 患者；27.0%），但少数患者接受了溶栓和 VA-ECMO（n=165；0.2%）、取栓和 VA-ECMO（n =385；0.5%）或 VA-ECMO 单独（n=588；0.8%）。多变量逻辑回归分析表明，接受栓子切除术联合 VA-ECMO（OR，0.50 [95%CI，0.41-0.61]，P<0.001）、溶栓和 VA-ECMO 的患者院内死亡风险最低（ 0.60 [0.43-0.85], P=0.003) 或单独使用 VA-ECMO (0.68 [0.57-0.82], P<0.001) 与单独溶栓相比 (1.04 [0.99-1.01], P=0.116)。

结论

我们的研究结果表明，单独使用 VA-ECMO 或作为包括栓子切除术或溶栓在内的多管齐下再灌注方法的一部分，与单纯溶栓相比，对于恶化至心脏骤停的 PE 患者，可能会提供生存优势。