Al-Bawardy Rasha, Rosenfield Kenneth, Borges Jorge, Young Michael N, Albaghdadi Mazen, Rosovsky Rachel, Kabrhel Christopher
1 Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
2 Department of Hematology, Massachusetts General Hospital, Boston, MA, USA.
Perfusion. 2019 Jan;34(1):22-28. doi: 10.1177/0267659118786830. Epub 2018 Jul 16.
Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry.
We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days.
Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%.
Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy.
体外膜肺氧合（ECMO）已被用于稳定大面积肺栓塞患者的病情，尽管相关报道较少。我们在肺栓塞反应团队（PERT）登记处描述了接受ECMO治疗大面积肺栓塞（PE）患者的临床表现、治疗及预后情况。
我们纳入了连续确诊为PE且PERT被激活的患者队列，并选择接受ECMO治疗的患者。我们前瞻性地收集了PERT激活时及随访期长达365天的临床、治疗及预后数据。
自2012年我们启动PERT项目以来，13例确诊为PE且PERT被激活的患者接受了ECMO治疗。平均年龄为49±19岁。6例（46%）为女性。所有患者均发生心脏骤停，要么作为初始表现，要么在就诊后发生院内心脏骤停。所有患者超声心动图均显示右心室（RV）扩张伴RV运动减弱。8例（62%）患者接受了静脉注射组织纤溶酶原激活剂（tPA）的全身溶栓治疗，3例（23%）患者使用EKOS系统（美国华盛顿州博塞尔市EKOS公司）接受了导管定向溶栓治疗。4例（31%）患者接受了手术取栓术。平均ECMO持续时间为5.5天，范围为2 - 18天。30天死亡率为31%，1年死亡率为54%。
发生心脏骤停的大面积肺栓塞患者发病率和死亡率较高。ECMO可与全身溶栓、导管定向治疗联合使用，或作为手术取栓术的桥梁。
