Ting-Wei Lin1, Meng-Ta Tsai2, Yu-Ning Hu2, Yi-Chen Wang2, Jih-Sheng Wen2, Hsuan-Yin Wu3, Chwan-Yau Luo2, Jun-Neng Roan4. 1. Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, E-DA hospital and College of Medicine, I-Shou University, Kaohsiung, Taiwan. 2. Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 3. Division of Cardiovascular Surgery, Department of Surgery, E-DA hospital and College of Medicine, I-Shou University, Kaohsiung, Taiwan. 4. Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: roanjunneng@mail.hosp.ncku.edu.tw.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used in patients with circulatory collapse or extremely unstable hemodynamics caused by acute massive pulmonary embolism (PE). The effectiveness of simultaneous thrombolytic therapy has been rarely investigated in these patients after being stabilized with ECMO. METHODS: From January 2008 to December 2018, consecutive patients with acute massive PE requiring ECMO supported in a tertiary medical center were included for retrospective analysis. RESULTS: Thirteen patients with PE underwent ECMO implantation and received subsequent thrombolytic therapy as a definite treatment for PE. All patients survived their ECMO courses to a successful de-cannulation, with a mean ECMO support duration of 6.23±4.69 days. Eleven (84.62%) of these patients survived to hospital discharge. All of these survivors were alive during the follow-up, although two (18.2%) of them had permanent dysfunctional neurological complications. Major bleeding complications occurred in four patients (30.77%), while none of them had intracranial hemorrhage. Systemic thrombolysis showed comparable outcomes of catheter-directed thrombolysis in our patients who underwent ECMO. CONCLUSIONS: Thrombolysis-based therapeutic strategy under ECMO could be a relatively safe and effective definitive treatment for patients with acute massive PE, even for those who were resuscitated. Bleeding complications remain a major concern and should be monitored and managed immediately.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used in patients with circulatory collapse or extremely unstable hemodynamics caused by acute massive pulmonary embolism (PE). The effectiveness of simultaneous thrombolytic therapy has been rarely investigated in these patients after being stabilized with ECMO. METHODS: From January 2008 to December 2018, consecutive patients with acute massive PE requiring ECMO supported in a tertiary medical center were included for retrospective analysis. RESULTS: Thirteen patients with PE underwent ECMO implantation and received subsequent thrombolytic therapy as a definite treatment for PE. All patients survived their ECMO courses to a successful de-cannulation, with a mean ECMO support duration of 6.23±4.69 days. Eleven (84.62%) of these patients survived to hospital discharge. All of these survivors were alive during the follow-up, although two (18.2%) of them had permanent dysfunctional neurological complications. Major bleeding complications occurred in four patients (30.77%), while none of them had intracranial hemorrhage. Systemic thrombolysis showed comparable outcomes of catheter-directed thrombolysis in our patients who underwent ECMO. CONCLUSIONS: Thrombolysis-based therapeutic strategy under ECMO could be a relatively safe and effective definitive treatment for patients with acute massive PE, even for those who were resuscitated. Bleeding complications remain a major concern and should be monitored and managed immediately.