دورية أكاديمية
Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation
| العنوان: | Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation |
|---|---|
| المؤلفون: | Corsi, Fillipo, Lebreton, Guillaume, Bréchot, Nicolas, Hekimian, Guillaume, Nieszkowska, Ania, Trouillet, Jean-Louis, Luyt, Charles-Edouard, Leprince, Pascal, Chastre, Jean, Combes, Alain, Schmidt, Matthieu |
| المساهمون: | Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart Roma (Unicatt), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition CHU Pitié Salpêtrière (IHU ICAN), CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) |
| المصدر: | ISSN: 1364-8535. |
| بيانات النشر: | HAL CCSD BioMed Central |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Cardiogenic shock, Extracorporeal membrane oxygenation, Long-term quality of life, Massive pulmonary embolism, [SDV]Life Sciences [q-bio] |
| الوصف: | International audience ; 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 II (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. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/28347320; hal-04008991; https://hal.science/hal-04008991Test; PUBMED: 28347320; PUBMEDCENTRAL: PMC5369216 |
| DOI: | 10.1186/s13054-017-1655-8 |
| الإتاحة: | https://doi.org/10.1186/s13054-017-1655-8Test https://hal.science/hal-04008991Test |
| رقم الانضمام: | edsbas.73F6C202 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s13054-017-1655-8 |
|---|