Extracorporeal membrane oxygenation for large pulmonary emboli

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Percutaneous procedures for massive and submassive pulmonary emboli (PE) are common.
• Patients with significant right ventricular strain during PE treatment risk hemodynamic compromise requiring extracorporeal membrane oxygenation (ECMO).

Purpose of the Study:

• To evaluate the outcomes of patients requiring ECMO support for PE.
• To identify complications associated with ECMO in PE patients.

Main Methods:

• Retrospective study of 10 patients requiring ECMO for PE from 2014-2022.
• Primary outcome: survival. Secondary outcomes: ECMO complications.
• Echocardiography assessed right ventricular strain; imaging identified PE location and extent.

Main Results:

• All 10 patients had right ventricular strain; 70% had saddle PE, 30% had bilateral PE.
• 60% required CPR before or during ECMO cannulation.
• 100% survived ECMO decannulation, 60% survived to discharge with no post-discharge mortality.

Conclusions:

• ECMO is a viable treatment for hemodynamically unstable PE patients.
• ECMO for PE is associated with acceptable morbidity and mortality.
• Further research is needed to identify patients at high risk for ECMO requirement.