Giraud Raphaël, Laurencet Matthieu, Assouline Benjamin, De Charrière Amandine, Banfi Carlo, Bendjelid Karim
Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland.
Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
J Clin Med. 2021 Jul 30;10(15):3376. doi: 10.3390/jcm10153376.
Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy.
All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed.
A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65-91.57, = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022-0.520, = 0.006).
The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.
伴有梗阻性心源性休克的大面积急性肺栓塞（MAPE）的死亡率超过50%。静脉-动脉体外膜肺氧合（VA-ECMO）已越来越多地用于难治性心源性休克，效果良好。在MAPE中，尽管目前它被推荐作为初始复苏的一部分，但尚未被视为一种独立的治疗方法。
对我院三级重症监护病房10年间收治的所有需要建立VA-ECMO的MAPE患者进行分析。提取并分析这些患者在ECMO治疗前、治疗期间和治疗后的特征。
本回顾性研究共纳入36例患者。总体生存率为64%。在大多数情况下，患者的血流动力学和呼吸状态在ECMO治疗的前24小时内显著改善。当ECMO作为独立治疗方法使用时，30天生存率显著提高（比值比（OR）15.58，95%置信区间（CI）2.65 - 91.57，P = 0.002）。然而，当在溶栓失败后植入ECMO时，出血并发症严重（17例（100%）对1例（5.3%）患者，P < 0.001），30天死亡率显著增加（OR 0.11，95% CI 0.022 - 0.520，P = 0.006）。
就接受VA-ECMO治疗的MAPE和休克患者数量而言，本回顾性研究无疑是最重要的研究之一。这种短期机械循环支持作为MAPE的独立治疗方法，可使患者实现最佳稳定状态。
