Life-threatening massive pulmonary embolism rescued by venoarterialextracorporeal membrane oxygenation

被引：154

作者：

Corsi, Fillipo ^{[1
,2
]}

Lebreton, Guillaume ^{[3
]}

Brechot, Nicolas ^{[2
]}

Hekimian, Guillaume ^{[2
]}

Nieszkowska, Ania ^{[2
]}

Trouillet, Jean-Louis ^{[2
]}

Luyt, Charles-Edouard ^{[2
]}

Leprince, Pascal ^{[3
]}

Chastre, Jean ^{[2
]}

Combes, Alain ^{[2
]}

Schmidt, Matthieu ^{[2
,4
]}

机构：

[1] Univ Cattolica Sacro Cuore, Policlin Univ A Gemelli, Dipartimento Anestesia & Rianimaz, Rome, Italy

[2] Univ Paris 06, Paris 6, Hop Pitie Salpetriere, AP HP,Med Intens Care Unit,iCAN, 47 Bd Hop, F-75651 Paris 13, France

[3] Univ Paris 06, Paris 6, Hop Pitie Salpetriere, AP HP,Cardiac Surg Dept,iCAN, 47 Bd Hop, F-75651 Paris 13, France

[4] Hop La Pitie Salpetriere, Serv Reanimat Med, iCAN, 47 Bd Hop, F-75651 Paris 13, France

来源：

CRITICAL CARE | 2017年 / 21卷

关键词：

Extracorporeal membrane oxygenation; Massive pulmonary embolism; Cardiogenic shock; Long-term; quality of life; REFRACTORY CARDIOGENIC-SHOCK; CARDIOPULMONARY-RESUSCITATION; CIRCULATORY SUPPORT; CARDIAC-ARREST; RISK-FACTORS; MANAGEMENT; SCORE; ECMO; HYPERTENSION; EMBOLECTOMY;

D O I：

10.1186/s13054-017-1655-8

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation. Methods: ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006-2015). Hospital-discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted. Results: Seventeen high-risk PE patients [median age 51 (range 18-70) years, Simplified Acute Physiology Score parallel to (SAPS II) 78 (45-95)] were placed on VA-ECMO for 4 (1-12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0-106) mmHg, 6.99 (6.54-7.37) and 13 (4-19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4-69) months post-ICU discharge. Conclusions: VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting.

引用

页数：10

共 40 条

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