Category: Critical Care
Keywords: cardiac arrest, massive pulmonary embolism, Venoarterial, ECMO (PubMed Search)
Posted: 5/4/2021 by Quincy Tran, MD, PhD
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Background:
Cardiac arrest from massive pulmonary embolism (PE) can be up to 90% (1). A recent systemic review evaluated the efficacy of Venoarterial-Extracorporeal Membrane Oxygenation (VA-ECMO) for PE-related cardiac arrest.
Results:
The authors screened 1115 articles and included 77 articles, including gray literature. The authors performed a quantitative analysis of a total of 301 patients.
Overall, 183/301 (61%) patients survived to hospital discharge, a significant improvement from 90%.
Patients who were cannulated during chest compression were associated with 7x higher odds of death (OR, 6.84; 95% CI, 1.53–30.58; p = 0.01), compared to those who were cannulated after ROSC. However, cannulation in the ED was not associated with improved outcomes, compared with other cannulation sites.
No increased risk of death among patients who received tPA prior to VA-ECMO vs. those who did not (OR, 0.78; 95% CI, 0.39–1.54; p = 0.48).
Patients whose age > 65 years of age were associated with 3X risk of death, compared to those with age < 65 years (OR, 3.56; 95% CI, 1.29–9.87; p = 0.02).
Take-home points
Please consider “early” VA-ECMO for eligible patients who have cardiac arrest from massive PE. However, it will take great convincing to push the PERT team to cannulate for VA-ECMO while the patient is still receiving chest compression.
1.Lavonas EJ, Drennan IR, Gabrielli A, et al: Part 10: Special circumstances of resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132:S501–S518.
2. Scott JH, Gordon M, Vender R, Pettigrew S, Desai P, Marchetti N, Mamary AJ, Panaro J, Cohen G, Bashir R, Lakhter V, Roth S, Zhao H, Toyoda Y, Criner G, Moores L, Rali P. Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review. Crit Care Med. 2021 May 1;49(5):760-769. doi: 10.1097/CCM.0000000000004828. PMID: 33590996
