In-Hospital Outcome in Patients Underwent Extracorporeal Membrane Oxygenation in Life-Threatening High-Risk Pulmonary Embolism.

Background And Objectives: Acute pulmonary embolism(PE) has high mortality and morbidity. Although reperfusion therapies can be used in high-risk PE patients, a few patients remain in a highly hemodynamically unstable state. In these patients, extracorporeal membrane oxygenation (ECMO) can be used to restore tissue oxygenation and improve their hemodynamic status. We retrospectively assessed the outcomes of ECMO in patients with high-risk PE.

Methods: We retrospectively screened all acute PE patients from January 2010 to December 2019 in 5 university hospitals in Korea. We reviewed their medical records and clinical outcomes.

Results: During the study period, we screened total 3,572 patients with PE and found 33 high-risk PE patients with ECMO (17 women, 58.3±14.7 years old) whose data were analyzed. Common causes of acute PE included limited mobility (8, 24.2%), a recent operation (6, 18.2%) and a recent hospitalization for medical diseases (3, 9.1%). Among the patients, 25 (75.0%) had a history of cardiopulmonary resuscitation. Nineteen patients had received primary therapy (intravenous thrombolysis in 10, thrombectomy in 8 and catheter-based thrombolysis in 1). The mean duration of ECMO was 5.0 days (range, 1-23 days). The in-hospital mortality rate was 51.5%. Twenty-two patients (66.7%) had ECMO related complications (15 [46.9%] had bleeding, 10 [31.3%] had an infection, and 5 [15.6%] had vascular complications). Of 15 cases with bleeding, 13 of them had mild bleeding associated with catheter insertion, and 2 had moderate multiorgan bleeding.

Conclusions: ECMO can be used as an additional or alternative circulatory support method in high-risk PE patients. However, physicians should keep in mind a high incidence of complications related to ECMO.