Zhou Zhenhang, Zhong Yaoyang, Hu Jianbo, Wu Zhonghua, Zou Liping, Deng Zhihe, Bi Guoshan, Shen Xin, Dai Xianpeng, Huang Zhijia, Xiong Guozuo, Xu Yiming, Deng Liming
Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
Hunan Province Thrombotic Disease Prevention and Treatment Clinical Medical Research Center, Hengyang, Hunan, China.
Front Cardiovasc Med. 2024 Dec 24;11:1457157. doi: 10.3389/fcvm.2024.1457157. eCollection 2024.
Percutaneous mechanical thrombectomy (PMT) is increasingly used in the treatment of intermediate and high-risk acute pulmonary embolism (PE), and the treatment of high-risk PE with the aid of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has also been reported. However, there are few reports of VA-ECOM-assisted PMT in the treatment of high-risk PE. The purpose of this study is to summarize the data of 11 patients with high-risk PE treated with VA-ECMO assisted PMT, and propose feasible treatment methods for such patients.
This multicenter retrospective study included patients with acute high-risk PE who were treated with VA-ECMO-assisted PMT from January 2021 to June 2024. The analysis focused on the right/left ventricle ratio, biomarkers, and pulmonary artery pressure before and after the VA-ECMO-assisted PMT treatment.
All 11 high-risk PE patients suffered cardiac arrest before treatment, computered tomograhy pulmonary angiography (CTPA) confirmed the diagnosis of PE, and all patients received VA-ECMO-assisted PMT therapy. The median age of the 11 patients was 54 years (range 18-72), the median duration of ECMO was 4.48 days (range 1.04-18.02), and the mean hospitalization time was 21 days (range 14-112). All patients received percutaneous thrombectomy, achieving a 100% technical success rate. The mortality rate was 27.3% during the 90-day follow-up. The 12-month mortality rate was 36.4%.
VA-ECMO-assisted PMT technology can rapidly improve pulmonary hemodynamics while maintaining stable blood flow, thereby reducing in-hospital mortality in high-risk patients with pulmonary embolism complicated by cardiac arrest.
经皮机械血栓切除术（PMT）在中高危急性肺栓塞（PE）治疗中的应用日益广泛，借助静脉-动脉体外膜肺氧合（VA-ECMO）治疗高危PE的相关报道也有出现。然而，关于VA-ECMO辅助PMT治疗高危PE的报道较少。本研究旨在总结11例接受VA-ECMO辅助PMT治疗的高危PE患者的数据，并为此类患者提出可行的治疗方法。
这项多中心回顾性研究纳入了2021年1月至2024年6月期间接受VA-ECMO辅助PMT治疗的急性高危PE患者。分析聚焦于VA-ECMO辅助PMT治疗前后的右/左心室比值、生物标志物和肺动脉压力。
11例高危PE患者在治疗前均发生心脏骤停，计算机断层扫描肺动脉造影（CTPA）确诊为PE，所有患者均接受了VA-ECMO辅助PMT治疗。11例患者的中位年龄为54岁（范围18 - 72岁），ECMO的中位持续时间为4.48天（范围1.04 - 18.02天），平均住院时间为21天（范围14 - 112天）。所有患者均接受了经皮血栓切除术，技术成功率达100%。90天随访期间死亡率为27.3%。12个月死亡率为36.4%。
VA-ECMO辅助PMT技术可在维持血流稳定的同时迅速改善肺血流动力学，从而降低合并心脏骤停的高危肺栓塞患者的院内死亡率。
