OPTIMAL REPERFUSION STRATEGY IN ACUTE HIGH-RISK PULMONARY EMBOLISM REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: A SYSTEMATIC REVIEW AND META-ANALYSIS
| Autor: | Romain Chopard, Peter Nielsen, Fabio Ius, Serghei Cebotari, Fiona Ecarnot, Hugo Pilichowski, Matthieu Schmidt, Benedict Kjaergaard, Iago Sousa-Casasnovas, Mehrdad Ghoreishi, Rajeev L. Narayan, Su Nam Lee, Gregory Piazza, Nicolas Meneveau |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
Extracorporeal Membrane Oxygenation/methods pulmonary embolism Embolectomy/methods Embolectomy Critical Care and Intensive Care Medicine pulmonary revascularization meta-analysis Extracorporeal Membrane Oxygenation Treatment Outcome Thrombolytic Therapy/methods Pulmonary Embolism/therapy Acute Disease Reperfusion Humans Thrombolytic Therapy Pulmonary Embolism Cardiology and Cardiovascular Medicine extra-corporeal membrane oxygenation |
| Zdroj: | Chopard, R, Nielsen, P, Ius, F, Cebotari, S, Ecarnot, F, Pilichowski, H, Schmidt, M, Kjaergaard, B, Sousa-Casasnovas, I, Ghoreishi, M, Narayan, R L, Nam Lee, S, Piazza, G & Meneveau, N 2022, ' Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support : a systematic review and meta-analysis ', The European Respiratory Journal, vol. 60, no. 5, 2102977 . https://doi.org/10.1183/13993003.02977-2021 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/s0735-1097(22)02780-2 |
| Popis: | BackgroundThe optimal pulmonary revascularisation strategy in high-risk pulmonary embolism (PE) requiring implantation of extracorporeal membrane oxygenation (ECMO) remains controversial.MethodsWe conducted a systematic review and meta-analysis of evidence comparing mechanical embolectomy and other strategies, including systemic thrombolysis, catheter-directed thrombolysis or ECMO as stand-alone therapy, with regard to mortality and bleeding outcomes.ResultsWe identified 835 studies, 17 of which were included, comprising 327 PE patients. Overall, 32.4% were treated with mechanical pulmonary reperfusion (of whom 85.9% had surgical embolectomy), while 67.6% received other strategies. The mortality rate was 22.6% in the mechanical reperfusion group and 42.8% in the “other strategies” group. The pooled odds ratio for mortality with mechanical reperfusion was 0.439 (95% CI 0.237–0.816) (p=0.009; I2=35.2%)versusother reperfusion strategies and 0.368 (95% CI 0.185–0.733) (p=0.004; I2=32.9%) for surgical embolectomyversusthrombolysis. The rate of bleeding in patients under ECMO was 22.2% in the mechanical reperfusion group and 19.1% in the “other strategies” group (OR 1.27, 95% CI 0.54–2.96; I2=7.7%). The meta-regression model did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy”, “ECMO implantation before pulmonary reperfusion therapy”, “clinical presentation of PE” or “cancer-associated PE” and the associated outcomes.ConclusionsThe results of the present meta-analysis and meta-regression suggest that mechanical reperfusion, notably by surgical embolectomy, may yield favourable results regardless of the timing of ECMO implantation in the reperfusion timeline, independent of thrombolysis administration or cardiac arrest presentation. |
| Databáze: | OpenAIRE |
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