Assouline Benjamin, Assouline-Reinmann Marie, Giraud Raphaël, Levy David, Saura Ouriel, Bendjelid Karim, Combes Alain, Schmidt Matthieu
Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
Cardiology Department, AP-HP, Sorbonne Université, Pitié-Salpêtrière University Hospital, 75013 Paris, France.
J Clin Med. 2022 Aug 13;11(16):4734. doi: 10.3390/jcm11164734.
Pulmonary embolism (PE) is a common disease with an annual incidence rate ranging from 39-115 per 100,000 inhabitants. It is one of the leading causes of cardiovascular mortality in the USA and Europe. While the clinical presentation and severity may vary, it is a life-threatening condition in its most severe form, defined as high-risk or massive PE. Therapeutic options in high-risk PE are limited. Current guidelines recommend the use of systemic thrombolytic therapy as first-line therapy (Level Ib). However, this treatment has important drawbacks including bleeding complications, limited efficacy in patients with recurrent PE or cardiac arrest, and formal contraindications. In this context, the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the management of high-risk PE has increased worldwide in the last decade. Strategies, including VA-ECMO as a stand-alone therapy or as a bridge to alternative reperfusion therapies, are associated with acceptable outcomes, especially if implemented before cardiac arrest. Nonetheless, the level of evidence supporting ECMO and alternative reperfusion therapies is low. The optimal management of high-risk PE patients will remain controversial until the realization of a prospective randomized trial comparing those cited strategies to systemic thrombolysis.
肺栓塞（PE）是一种常见疾病，年发病率为每10万居民39 - 115例。它是美国和欧洲心血管疾病死亡的主要原因之一。虽然临床表现和严重程度可能有所不同，但最严重形式的肺栓塞，即高危或大面积肺栓塞，是一种危及生命的疾病。高危肺栓塞的治疗选择有限。当前指南推荐使用全身溶栓治疗作为一线治疗（Ib级）。然而，这种治疗有重要缺点，包括出血并发症、对复发性肺栓塞或心脏骤停患者疗效有限以及存在明确的禁忌证。在此背景下，在过去十年中，静脉 - 动脉体外膜肺氧合（VA - ECMO）在高危肺栓塞管理中的应用在全球范围内有所增加。包括将VA - ECMO作为单一疗法或作为替代再灌注疗法的桥梁等策略，与可接受的结果相关，特别是如果在心脏骤停前实施。尽管如此，支持ECMO和替代再灌注疗法的证据水平较低。在进行一项比较上述策略与全身溶栓的前瞻性随机试验之前，高危肺栓塞患者的最佳管理仍将存在争议。
