Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study

• DOI: 10.1007/s00134-024-07501-9
• Publication Date: 2024-06-24T14:02:14Z
• Authors: David Levy; Ouriel Saura; Maria Teresa Pass...; Manuela Lucenteforte; Guillaume Lebreton; Adrien Bougle; Antoine Monsel; Sofia Ortuno; Yoël Benitha; Nadjib Hammoudi; Benjamin Assouline; Matthieu Petit; Melchior Gautier; Lucie Le Fevre; Marc Pineton de C...; Charles Juvin; Juliette Chommeloux; Charles-Edouard Luyt; Guillaume Hékimian; Pascal Leprince; Alain Combes; Matthieu Schmidt
• Keywords: Male; Adult; Extracorporeal Membrane Oxygenation; Treatment Outcome; Quality of Life; Humans; Female; Thrombolytic Therapy; Middle Aged; Pulmonary Embolism; Retrospective Studies

Despite systemic thrombolysis, a few patients with high-risk pulmonary embolism (PE) remain hemodynamically unstable. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a considerable lifesaving therapy but systemic thrombolysis before cannulation could carry a high risk of hemorrhage and alter the prognosis.Between June 2012 and June 2023, we retrospectively analyzed from three intensive care units in Sorbonne University, ECMO-related complications and 90-day mortality for high-risk PE patients who received ECMO without previous systemic thrombolysis compared to those cannulated after systemic thrombolysis failure. Hospital discharge survivors were assessed for long-term health-related quality of life and echocardiographic evaluations.72 high-risk PE patients [median age 48 (37-61) years, Simplified Acute Physiology Score II (SAPS II) 74 (60-85)] were placed on VA-ECMO for 5 (5-7) days. 31 (43%) patients underwent pre-ECMO thrombolysis (thrombolysis ECMO group, T +) compared to 41 patients (57%, no thrombolysis ECMO group, T-). There was more pre-ECMO cardiac arrest in the thrombolysis ECMO group (94% vs. 67%, p = 0.02). Ninety-day survival was not different between groups (39% vs 46%, log-rank test, p = 0.31). There was no difference in severe hemorrhages (61% vs 59%, p = 1). Twenty-five over 28 patients attended follow-up at a median time of 69 (52-95) months. Long-term quality of life was acceptable and none of them experienced chronic thromboembolic pulmonary hypertension.Ninety-day survival and bleeding events rates did not differ in patients treated with VA-ECMO after systemic thrombolysis compared to those who were not. Recent systemic thrombolysis, as a single parameter, should not be considered as a contraindication for VA-ECMO in high-risk PE.