ArticleIntensive care medicine2024
Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study.
Article in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Initial management of intermediate- and high-risk pulmonary embolism.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Review
- CRRT and ECMO: one love or separate lives?Intensive care medicine · 2026Article
- Outcomes of Venous-Arterial Extracorporeal Membrane Oxygenation Therapy in Acute Pulmonary Embolism: A Single-Center Experience.Journal of thrombosis and thrombolysis · 2026Article
- Perioperative venous thromboembolism salvage via VA-ECMO-bridged surgical thrombectomy: A case report.Respiratory medicine case reports · 2026Article
- Article
- Predictors of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) failure: analysis of comorbidities and complications - a 10-year experience.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2025Article
- Personalized strategies for high-risk acute pulmonary embolism: addressing the "catastrophic" subgroup.Intensive care medicine · 2025Article
- Management of high-risk acute pulmonary embolism: an emulated target trial analysis.Intensive care medicine · 2025Observational
- Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2.Journal of intensive care · 2024Article
Corrections and comments
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Authors and funding
22 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDespite systemic thrombolysis, a few patients with high-risk pulmonary embolism (PE) remain hemodynamically unstable. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a considerable lifesaving therapy but systemic thrombolysis before cannulation could carry a high risk of hemorrhage and alter the prognosis.
methodsBetween June 2012 and June 2023, we retrospectively analyzed from three intensive care units in Sorbonne University, ECMO-related complications and 90-day mortality for high-risk PE patients who received ECMO without previous systemic thrombolysis compared to those cannulated after systemic thrombolysis failure. Hospital discharge survivors were assessed for long-term health-related quality of life and echocardiographic evaluations.
results72 high-risk PE patients [median age 48 (37-61) years, Simplified Acute Physiology Score II (SAPS II) 74 (60-85)] were placed on VA-ECMO for 5 (5-7) days. 31 (43%) patients underwent pre-ECMO thrombolysis (thrombolysis ECMO group, T +) compared to 41 patients (57%, no thrombolysis ECMO group, T-). There was more pre-ECMO cardiac arrest in the thrombolysis ECMO group (94% vs. 67%, p = 0.02). Ninety-day survival was not different between groups (39% vs 46%, log-rank test, p = 0.31). There was no difference in severe hemorrhages (61% vs 59%, p = 1). Twenty-five over 28 patients attended follow-up at a median time of 69 (52-95) months. Long-term quality of life was acceptable and none of them experienced chronic thromboembolic pulmonary hypertension.
conclusionsNinety-day survival and bleeding events rates did not differ in patients treated with VA-ECMO after systemic thrombolysis compared to those who were not. Recent systemic thrombolysis, as a single parameter, should not be considered as a contraindication for VA-ECMO in high-risk PE.
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