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Outcomes with use of extra-corporeal membrane oxygenation in high-risk pulmonary embolism: a national database perspective

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Abstract

High-risk pulmonary embolism (PE) patients can be managed with systemic lysis, catheter-based therapies, or surgical embolectomy. Despite the advent of newer therapies, patients with high-risk PE remain with a 50–60% short-term mortality risk. In such patients, extracorporeal membrane oxygenation (ECMO) is increasingly utilized for hemodynamic support. To evaluate the outcomes of the use of ECMO in patients with high-risk PE. Using the National Inpatient Sample (NIS) database, we identified patients with high-risk PE using ICD 10 codes and compared in-hospital outcomes of patients with and without ECMO support. We identified 38,035 patients with high-risk PE, of whom 820 had undergone ECMO placement. Most patients who underwent ECMO were male (54%), white (65%), and with a mean age of 53.7 years. ECMO use was not associated with a meaningful difference in patient mortality when comparing treatment groups (OR, 1.32 ± 0.39; 0.74–2.35; p = 0.35). Rather, ECMO use was associated with a higher frequency of inpatient complications. ECMO use was not associated with a significant difference in patient mortality in patients with high-risk PE.

Highlights

  • Of 38,035 patients identified in an administrative database to have high risk pulmonary embolism, outcomes were evaluated for those who underwent mechanical cardiac support with extracorporeal membrane oxygenation for right ventricular failure.

  • After propensity-matching, 1560 patients (one-half with extracorporeal membrane oxygenation), length of hospital stay was longer if mechanical cardiac assistance was instituted and 40% of patients ultimately died.

  • Overall, extracorporeal membrane oxygenation did not improve patient mortality in the context of high-risk pulmonary embolism, and increased the frequency of gastrointestinal bleeding, blood transfusion requirements, vascular access complications, and acute kidney injury.

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Data availability

Data or code will be made available on request from the first author: Dr. Farhan Nasser: farhannasser@gmail.com

References

  1. Heit JA (2008) The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 28(3):370–372. https://doi.org/10.1161/ATVBAHA.108.162545

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. The Lancet 379(9828):1835–1846

    Article  Google Scholar 

  3. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM (2018) Epidemiology, pathophysiology, and natural history of pulmonary embolism. Semin Intervent Radiol 35(2):92–98

    Article  PubMed  PubMed Central  Google Scholar 

  4. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, ESC Scientific Document Group (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J 41(4):543–603

    Article  PubMed  Google Scholar 

  5. Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). The Lancet 353(9162):1386–1389

    Article  CAS  Google Scholar 

  6. Vandenbriele C, Van Edom C, Tavazzi G. Anticoagulant management for transition from failed thrombolysis to extra-corporeal membrane oxygenation in patients with high-risk pulmonary embolism: A thoughtful approach. International Journal of Cardiology [Internet]. 22 Oct 2022 [cited 27 Nov 2022]; Available from: https://www.sciencedirect.com/science/article/pii/S0167527322016497

  7. Tamariz L, Harkins T, Nair V (2012) A systematic review of validated methods for identifying venous thromboembolism using administrative and claims data. Pharmacoepidemiol Drug Saf 21(Suppl 1):154–162

    Article  PubMed  Google Scholar 

  8. Smith SB, Geske JB, Kathuria P, Cuttica M, Schimmel DR, Courtney DM, Waterer GW, Wunderink RG (2016) Analysis of national trends in admissions for pulmonary embolism. Chest 150(1):35–45

    Article  PubMed  PubMed Central  Google Scholar 

  9. Elbadawi A, Mentias A, Elgendy IY, Mohamed AH, Syed MH, Ogunbayo GO, Olorunfemi O, Gosev I, Prasad S, Cameron SJ (2019) National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism. Vasc Med 24(3):230–233

    Article  PubMed  PubMed Central  Google Scholar 

  10. Corsi F, Lebreton G, Bréchot N, Hekimian G, Nieszkowska A, Trouillet JL, Luyt CE, Leprince P, Chastre J, Combes A, Schmidt M (2017) Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation. Crit Care 21(1):76

    Article  PubMed  PubMed Central  Google Scholar 

  11. George B, Parazino M, Omar HR, Davis G, Guglin M, Gurley J, Smyth S (2018) A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support. Resuscitation 1(122):1–5

    Article  Google Scholar 

  12. Baldetti L, Beneduce A, Cianfanelli L, Falasconi G, Pannone L, Moroni F, Venuti A, Sacchi S, Gramegna M, Pazzanese V, Calvo F, Gallone G, Pagnesi M, Cappelletti AM (2021) Use of extracorporeal membrane oxygenation in high-risk acute pulmonary embolism: a systematic review and meta-analysis. Artif Organs 45(6):569–576

    Article  PubMed  Google Scholar 

  13. Pozzi M, Metge A, Martelin A, Giroudon C, Lanier Demma J, Koffel C, Fornier W, Chiari P, Fellahi JL, Obadia JF, Armoiry X (2020) Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: a systematic review and meta-analysis. Vasc Med 25(5):460–467

    Article  PubMed  Google Scholar 

  14. Alhussein M, Moayedi Y, Posada JD, Ross H, Hickey E, Rao V, Billia F (2017) Ventricular thrombosis post-venoarterial extracorporeal membrane oxygenation. Circ Heart Fail 10(2):e003757

    Article  PubMed  Google Scholar 

  15. Vandenbriele C, Arachchillage DJ, Frederiks P, Giustino G, Gorog DA, Gramegna M, Janssens S, Meyns B, Polzin A, Scandroglio M, Schrage B, Stone GW, Tavazzi G, Vanassche T, Vranckx P, Westermann D, Price S, Chieffo A (2022) Anticoagulation for percutaneous ventricular assist device-supported cardiogenic shock: JACC review topic of the week. J Am Coll Cardiol 79(19):1949–1962

    Article  CAS  PubMed  Google Scholar 

  16. Murphy DA, Hockings LE, Andrews RK, Aubron C, Gardiner EE, Pellegrino VA, Davis AK (2015) Extracorporeal membrane oxygenation—hemostatic complications. Transfus Med Rev 29(2):90–101

    Article  PubMed  Google Scholar 

  17. Meneveau N, Guillon B, Planquette B, Piton G, Kimmoun A, Gaide-Chevronnay L, Aissaoui N, Neuschwander A, Zogheib E, Dupont H, Pili-Floury S, Ecarnot F, Schiele F, Deye N, de Prost N, Favory R, Girard P, Cristinar M, Ferré A, Meyer G, Capellier G, Sanchez O (2018) Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases. Eur Heart J 39(47):4196–4204

    Article  PubMed  Google Scholar 

  18. Pasrija C, Kronfli A, Rouse M, Raithel M, Bittle GJ, Pousatis S, Ghoreishi M, Gammie JS, Griffith BP, Sanchez PG, Kon ZN (2018) Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: a single-center experience. J Thorac Cardiovasc Surg 155(3):1095-1106.e2

    Article  PubMed  Google Scholar 

  19. Goldberg JB, Spevack DM, Ahsan S, Rochlani Y, Dutta T, Ohira S, Kai M, Spielvogel D, Lansman S, Malekan R (2020) Survival and right ventricular function after surgical management of acute pulmonary embolism. J Am Coll Cardiol 76(8):903–911

    Article  PubMed  Google Scholar 

  20. Giraud R, Legouis D, Assouline B, De Charriere A, Decosterd D, Brunner ME, Moret-Bochatay M, Fumeaux T, Bendjelid K (2021) Timing of VV-ECMO therapy implementation influences prognosis of COVID-19 patients. Physiol Rep 9(3):e14715

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ostadal P, Rokyta R, Karasek J, Kruger A, Vondrakova D, Janotka M, Naar J, Smalcova J, Hubatova M, Hromadka M, Volovar S, Seyfrydova M, Jarkovsky J, Svoboda M, Linhart A, Belohlavek J (2022) extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO-CS randomized clinical trial. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.122.062949

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding support from the National Institutes of Health, R01HL158801 (to SJC).

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Authors and Affiliations

  1. Heart and Vascular Center, Case Western Reserve University, MetroHealth Campus, Cleveland, OH, USA

    Mohamed Farhan Nasser & Ahmad Jabri

  2. Department of Internal Medicine, St. Barnabas Hospital Health System, New York, NY, USA

    Shorabh Sharma

  3. Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA

    Laith Alhuneafat

  4. Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA

    Yazan Abu Omar

  5. Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, MetroHealth Campus, Cleveland, OH, USA

    Vidya Krishnan

  6. Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Desk J-35, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Scott J. Cameron

Authors
  1. Mohamed Farhan Nasser
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  2. Ahmad Jabri
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  3. Shorabh Sharma
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  4. Laith Alhuneafat
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  5. Yazan Abu Omar
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  6. Vidya Krishnan
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  7. Scott J. Cameron
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Contributions

M.F.N, A.J: conceptualization. M.F.N, A.J: methodology and analysis. M.F.N, S.S, V.K, S.C: writing: review and editing. L.A, Y.A.O: editing and figure design. S.C: supervision.

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Correspondence to Scott J. Cameron.

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Nasser, M.F., Jabri, A., Sharma, S. et al. Outcomes with use of extra-corporeal membrane oxygenation in high-risk pulmonary embolism: a national database perspective. J Thromb Thrombolysis 55, 499–505 (2023). https://doi.org/10.1007/s11239-023-02773-2

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  • DOI: https://doi.org/10.1007/s11239-023-02773-2

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