التفاصيل البيبلوغرافية
| 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 |
| المصدر: |
Critical Care; 3/28/2017, Vol. 21, p1-10, 10p |
| مصطلحات موضوعية: |
APACHE (Disease classification system), EXTRACORPOREAL membrane oxygenation, INTENSIVE care units, NONPARAMETRIC statistics, PULMONARY embolism, SURVIVAL analysis (Biometry), SPECIALTY hospitals, RETROSPECTIVE studies, SEVERITY of illness index, THERAPEUTICS |
| مصطلحات جغرافية: |
FRANCE |
| مستخلص: |
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. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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