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Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism as Bridge to Therapy

Kmiec, Lukasz*; Philipp, Alois*; Floerchinger, Bernhard*; Lubnow, Matthias; Unterbuchner, Christoph; Creutzenberg, Markus; Lunz, Dirk; Mueller, Thomas; Schmid, Christof*; Camboni, Daniele*

doi: 10.1097/MAT.0000000000000953
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Pulmonary Embolism (PE) is a common illness in western countries. The purpose of this study is to report the institutional experience with massive PE and Extracorporeal Membrane Oxygenation (ECMO) in inoperable patients on admission. A retrospective analysis using the institutional ECMO-registry including the time between 2006 and 2017 was performed. During the study period, 75 patients (n = 46 patients venoarterial [VA], n = 29 patients venovenous [VV]) were placed on ECMO for massive PE. The primary support for massive PE consists of VA; however, VV support can be applied as well in selected cases as this work demonstrates. In the VA group, more patients (38 vs. 83%, P = 0.001) required mechanical resuscitation whereas in the VV group a more aggressive ventilation before support was noted (e.g. minute ventilation: VA=8.8 ± 3.7 L/min, VV=11.5 ± 4.5 L/min, P = 0.01). Survival to discharge was similar in VV and VA patients (45 vs. 48%, P = 0.9). Patients who received additional therapeutic interventions after stabilization with ECMO – e.g. surgical thrombectomy – displayed a similar survival compared with those being only anticoagulated (44% vs. 49%, P = 0.40). ECMO is feasible for initial stabilization serving as a bridge to therapy in primarily inoperable patients with massive PE. The principal configuration of support is VA; however, VV can be applied as well in selected hemodynamically compromised cases under aggressive ventilation.

From the *Department of Cardiothoracic Surgery

Department of Internal Medicine II

Department of Anaesthesia.

Submitted for consideration April 2018; accepted for publication in revised form December 2018.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Daniele Camboni, Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Email: daniele.camboni@ukr.de.

Copyright © 2019 by the American Society for Artificial Internal Organs