Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA.
Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
Catheter Cardiovasc Interv. 2022 Aug;100(2):274-278. doi: 10.1002/ccd.30295. Epub 2022 Jun 10.
Massive or high-risk pulmonary embolism (PE) is a potentially life-threatening diagnosis with significant morbidity and mortality if treatment is delayed. Extracorporeal membrane oxygenation (ECMO) and large bore thrombectomy (LBT) in isolation have been used to stabilize and treat patients with massive PE, however, literature describing the combination of both modalities is lacking. We present a case series involving 9 patients who underwent combined ECMO and LBT and their outcomes.
This was a retrospective chart review of patients with confirmed PE, who underwent LBT and ECMO. We retrospectively captured clinical, therapeutic, and outcome data at the time of pulmonary embolism response team (PERT) activation and during the follow-up period for up to 90 days.
Nine patients who had PERT activation with confirmed PE diagnosis have undergone combined LBT and ECMO initiation since the advent of our PERT program. The median age was 57 (range 28-68) years. Six patients out of 9 (55%) had cardiac arrest before therapy. All patients exhibited right heart strain on computed tomography and echocardiogram. The median ECMO duration was 5 days (range 2.3-11.6 days), with mean hospitalization of 16.1 days (range 1.5-30.9). Mortality was 22% at 90-day follow-up period.
Patients with massive pulmonary embolism who suffer cardiac arrest have significant morbidity and mortality. ECMO in combination with LBT is a viable treatment option for patients with significant hemodynamic compromise.
大面积或高危肺栓塞（PE）是一种潜在的危及生命的诊断，如果治疗延迟，会导致严重的发病率和死亡率。体外膜氧合（ECMO）和大口径血栓切除术（LBT）单独用于稳定和治疗大面积 PE 患者，但缺乏同时使用这两种方法的文献描述。我们报告了 9 例接受 ECMO 和 LBT 联合治疗的患者及其结果的病例系列。
这是一项对接受 LBT 和 ECMO 的确诊 PE 患者进行回顾性图表审查。我们回顾性地在肺栓塞反应小组（PERT）激活时和随访期间（最长 90 天）捕获临床、治疗和结局数据。
自我们的 PERT 计划启动以来，9 例 PERT 激活且确诊为 PE 的患者接受了联合 LBT 和 ECMO 治疗。中位年龄为 57 岁（范围 28-68 岁）。9 例患者中有 6 例（55%）在治疗前发生心脏骤停。所有患者的计算机断层扫描和超声心动图均显示右心劳损。中位 ECMO 持续时间为 5 天（范围 2.3-11.6 天），平均住院时间为 16.1 天（范围 1.5-30.9 天）。90 天随访期的死亡率为 22%。
发生心脏骤停的大面积肺栓塞患者发病率和死亡率高。ECMO 联合 LBT 是治疗严重血流动力学不稳定患者的可行治疗选择。
