Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

Nicolas Meneveau (1) , Benoit Guillon (2) , Benjamin Planquette (3) , Gael Piton (4, 1) , Antoine Kimmoun (5, 6, 7) , Lucie Gaide-Chevronnay (8) , Nadia Aissaoui (9) , Arthur Neuschwander (10) , Elie Zogheib (11) , Herve Dupont (12, 13) , Sebastien Pili-Floury (14) , Fiona Ecarnot (1) , Francois Schiele (1) , Nicolas Deye (15) , Nicolas De Prost (16) , Raphael Favory (17, 18, 19) , Philippe Girard (20) , Mircea Cristinar , Alexis Ferre (3) , Guy Meyer (21, 22, 23, 24) , Gilles Capellier (4, 1) , Olivier Sanchez (25)

1 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes
3 CHV - Centre Hospitalier de Versailles André Mignot
4 Réanimation Médicale CHRU Besançon
5 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
6 Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]
7 Service de Réanimation Médicale [CHRU Nancy]
8 UGA UFRM - Université Grenoble Alpes - UFR Médecine
9 HEGP - Hôpital Européen Georges Pompidou [APHP]
10 Hôpital Beaujon [AP-HP]
11 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
12 CHU Amiens-Picardie
13 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
14 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
15 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
16 DHU A-TVB - Réanimation Médicale [CHU Henri Mondor - APHP]
17 Service de soins intensifs
18 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
19 LIRIC - Lille Inflammation Research International Center - U 995
20 IMS - Laboratoire de l'intégration, du matériau au système
21 UPD5 - Université Paris Descartes - Paris 5
22 CIC 1418 - CIC - HEGP
23 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
24 Pneumo - HEGP - Service de Pneumologie, soins intensifs
25 IMRB - Institut Mondor de recherche biomédicale

Aims: The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred and twenty-eight patients were treated without ECMO; 52 (mean age 47.6 years) underwent ECMO. Overall 30-day mortality was 48.3% [95% confidence interval (CI) 41-56] (87/180); 43% (95% CI 34-52) (55/128) in those treated without ECMO vs. 61.5% (95% CI 52-78) (32/52) in those with ECMO (P = 0.008). In patients undergoing ECMO, 30-day mortality was 76.5% (95% CI 57-97) (13/17) for ECMO+fibrinolysis, 29.4% (95% CI 51-89) (5/17) for ECMO+surgical embolectomy, and 77.7% (95% CI 59-97) (14/18) for ECMO alone (P = 0.004). Among patients with ECMO, 20 (38.5%, 95% CI 25-52) had a major bleeding event in-hospital; without significant difference across groups. Conclusion In patients with high-risk PE, those with ECMO have a more severe presentation and worse prognosis. Extracorporeal membrane oxygenation in patients with failed fibrinolysis and in those with no reperfusion seems to be associated with particularly unfavourable prognosis compared with ECMO performed in addition to surgical embolectomy. Our findings suggest that ECMO does not appear justified as a stand-alone treatment strategy in PE patients, but shows promise as a complement to surgical embolectomy.

Domaines: Sciences du Vivant [q-bio]

Nicolas Meneveau, Benoit Guillon, Benjamin Planquette, Gael Piton, Antoine Kimmoun, et al.. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases. European Heart Journal, 2018, 39 (47), p.4196-4204. ⟨10.1093/eurheartj/ehy464⟩. ⟨hal-03577387⟩