• Mina Karami, Loes Mandigers, MirandaDinis Dos ReisDDRDepartment of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands., Wim J R Rietdijk, Jan M Binnekade, Daniëlle C M Knijn, Wim K Lagrand, Corstiaan A den Uil, HenriquesJosé P SJPSHeart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., VlaarAlexander P JAPJDepartment of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: a.p.vlaar@amsterdamumc.nl., and DUTCH ECLS Study Group.
• Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
• J Crit Care. 2021 Aug 1; 64: 245-254.

BackgroundTo examine whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) improves survival of patients with acute pulmonary embolism (PE).MethodsFollowing the PRISMA guidelines, a systematic search was conducted up to August 2019 of the databases: PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of adult patients with acute PE treated with VA-ECMO and including four patients or more were included. Exclusion criteria were: correspondences, reviews and studies in absence of a full text, written in other languages than English or Dutch, or dating before 1980. Short-term (hospital or 30-day) survival data were pooled and presented with relative risks (RR) and 95% confidence intervals (95% CI). Also, the following pre-defined factors were evaluated for their association with survival in VA-ECMO treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest, surgical embolectomy, catheter directed therapy, systemic thrombolysis, and VA-ECMO as single therapy.ResultsA total of 29 observational studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N = 809). There was no difference in short-term survival between VA-ECMO treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In acute PE patients undergoing VA-ECMO, age > 60 years was associated with lower survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was associated with higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI 0.77-1.01). The other evaluated factors were not associated with a difference in survival.ConclusionsAt present, there is insufficient evidence that VA-ECMO treatment improves short-term survival of acute PE patients. Low quality evidence suggest that VA-ECMO patients aged ≤60 years or who received SE have higher survival rates. Considering the limited evidence derived from the present data, this study emphasizes the need for prospective studies.Protocol RegistrationPROSPERO CRD42019120370.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

16 keywords...

hide…