Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：尽管全身溶栓，少数高危肺栓塞(PE)患者血流动力学仍不稳定.静脉动脉体外膜氧合（VA-ECMO）是一种重要的挽救生命的疗法，但插管前的全身溶栓可能会带来很高的出血风险并改变预后。
方法：在2012年6月至2023年6月之间，我们回顾性分析了索邦大学的三个重症监护病房，与全身溶栓失败后插管相比，接受ECMO的高风险PE患者的ECMO相关并发症和90天死亡率。评估出院幸存者的长期健康相关生活质量和超声心动图评估。
结果：72例高危PE患者[中位年龄48（37-61）岁，将简化的急性生理学评分II(SAPSII)74(60-85)]置于VA-ECMO上5(5-7)天。31例(43%)患者接受了ECMO前溶栓(溶栓ECMO组,T+)与41例患者(57%，无溶栓ECMO组,T-).溶栓ECMO组ECMO前心脏骤停更多(94%vs.67%,p=0.02)。90天生存率在组间没有差异（39%vs46%，对数秩检验，p=0.31）。严重出血没有差异（61%vs59%，p=1)。28名以上的25名患者参加了中位时间为69（52-95）个月的随访。长期生活质量是可以接受的，没有人经历慢性血栓栓塞性肺动脉高压。
结论：全身溶栓后接受VA-ECMO治疗的患者与未接受治疗的患者相比，90天生存率和出血事件发生率无差异。近期全身溶栓,作为单个参数，不应将其视为高危PE中VA-ECMO的禁忌症。
方法：在2012年6月至2023年6月之间，我们回顾性分析了索邦大学的三个重症监护病房，与全身溶栓失败后插管相比，接受ECMO的高风险PE患者的ECMO相关并发症和90天死亡率。评估出院幸存者的长期健康相关生活质量和超声心动图评估。
结果：72例高危PE患者[中位年龄48（37-61）岁，将简化的急性生理学评分II(SAPSII)74(60-85)]置于VA-ECMO上5(5-7)天。31例(43%)患者接受了ECMO前溶栓(溶栓ECMO组,T+)与41例患者(57%，无溶栓ECMO组,T-).溶栓ECMO组ECMO前心脏骤停更多(94%vs.67%,p=0.02)。90天生存率在组间没有差异（39%vs46%，对数秩检验，p=0.31）。严重出血没有差异（61%vs59%，p=1)。28名以上的25名患者参加了中位时间为69（52-95）个月的随访。长期生活质量是可以接受的，没有人经历慢性血栓栓塞性肺动脉高压。
结论：全身溶栓后接受VA-ECMO治疗的患者与未接受治疗的患者相比，90天生存率和出血事件发生率无差异。近期全身溶栓,作为单个参数，不应将其视为高危PE中VA-ECMO的禁忌症。
