Outcomes of extracorporeal life support for the treatment of acute massive pulmonary embolism: A systematic review
| Autor: | Taki Galanis, Vakhtang Tchantchaleishvili, Martín Mellado, Nicholas D. D’Antonio, Carin F. Gonsalves, Bharat Awsare, Chelsey T. Wood, Geno J. Merli, Frances Mae West, Thomas J. O’Malley, Jae Hwan Choi, Elizabeth J. Maynes, Gregary D. Marhefka |
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| Rok vydání: | 2019 |
| Předmět: |
endocrine system
medicine.medical_treatment Embolectomy 030204 cardiovascular system & hematology Emergency Nursing Severity of Illness Index Extracorporeal law.invention 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation law medicine.artery medicine Humans Dialysis business.industry 030208 emergency & critical care medicine Thrombolysis medicine.disease Intensive care unit Pulmonary embolism Life Support Care Treatment Outcome Anesthesia Pulmonary artery Emergency Medicine Median Heart Rate Cardiology and Cardiovascular Medicine business Pulmonary Embolism |
| Zdroj: | Resuscitation. 146 |
| ISSN: | 1873-1570 |
| Popis: | Background Massive pulmonary embolism (PE) can cause hemodynamic instability leading to high mortality. Extracorporeal life support (ECLS) has been increasingly used as a bridge to definitive therapy. This systematic review investigates the outcomes of ECLS for the treatment of massive PE. Methods Electronic search was performed to identify all relevant studies published on ECLS use in patients with PE. 50 case series or reports were selected comprising 128 patients with acute massive PE who required ECLS. Patient-level data were extracted for statistical analysis. Results Median patient age was 50 [36, 63] years and 41.3% (50/121) were male. 67.2% (86/128) of patients presented with cardiac arrest. Median heart rate was 126 [118, 135] and median systolic pulmonary artery pressure (sPAP) was 55 [48, 69] mmHg. The majority of ECLS included veno-arterial ECLS [97.1% (99/102)]. Median ECLS time was 3 [2, 6] days. 43.0% (55/128) patients received systemic thrombolysis, 22.7% (29/128), received catheter-guided thrombolysis, and 37.5% (48/128) underwent surgical embolectomy. 85.1% (97/114) were weaned off ECLS. Post-ECLS complications included bleeding in 23.4% (30/128), acute renal failure in 8.6% (11/128), dialysis in 6.3% (8/128), heparin-induced thrombocytopenia in 3.1 (4/128), and extremity hypoperfusion in 2.3% (3/128). The most common cause of death was shock at 30.3% (10/33). The median length of hospital stay was 22 [11, 39] days including 8 [5, 13] intensive care unit (ICU) days. The 30-day mortality rate was 22% (20/91). Conclusions ECLS is safe and effective therapy in unstable patients with acute massive pulmonary embolism and offers acceptable outcomes. |
| Databáze: | OpenAIRE |
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