title: Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation.
  
  
  METHODS
  ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006-2015). Hospital- discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted.
  
  
  RESULTS
  Seventeen high-risk PE patients [median age 51 (range 18-70) years, Simplified Acute Physiology Score II (SAPS II) 78 (45-95)] were placed on VA-ECMO for 4 (1-12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0-106) mmHg, 6.99 (6.54-7.37) and 13 (4-19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4-69) months post-ICU discharge.
  
  
  CONCLUSIONS
  VA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting.
authors.affiliation: Dipartimento di Anestesia e Rianimazione, Policlinico Universitario A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy.|Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Fillipo
authors.initials: F
authors.lastname: Corsi
authors.affiliation: Cardiac Surgery Department, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Hekimian
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Ania
authors.initials: A
authors.lastname: Nieszkowska
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Cardiac Surgery Department, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.affiliation: Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.|Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010297:Paris; D011655:Pulmonary Embolism / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Long-term quality of life; Massive pulmonary embolism