Venoarterial Extracorporeal Membrane Oxygenation for Acute Massive Pulmonary Embolism: a Meta-Analysis and Call to Action

Elona Rrapo Kaso; Jonathan A Pan; Michael Salerno; Alexandra Kadl; Chad Aldridge; Ziv J Haskal; Jamie L W Kennedy; Sula Mazimba; Andrew D Mihalek; Nicholas R Teman; Jay Giri; Herbert D Aronow; Aditya M Sharma

doi:10.1007/s12265-021-10158-0

Venoarterial Extracorporeal Membrane Oxygenation for Acute Massive Pulmonary Embolism: a Meta-Analysis and Call to Action

J Cardiovasc Transl Res. 2022 Apr;15(2):258-267. doi: 10.1007/s12265-021-10158-0. Epub 2021 Jul 19.

Authors

Elona Rrapo Kaso¹, Jonathan A Pan¹, Michael Salerno^{1

2

3}, Alexandra Kadl⁴, Chad Aldridge⁵, Ziv J Haskal², Jamie L W Kennedy⁶, Sula Mazimba¹, Andrew D Mihalek⁴, Nicholas R Teman⁷, Jay Giri⁸, Herbert D Aronow⁹, Aditya M Sharma¹⁰

Affiliations

¹ Department of Medicine, Cardiovascular Division, University of Virginia, 1215 Lee Street, Charlottesville, VA, USA.
² Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
³ Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
⁴ Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Therapy Services, University of Virginia, Charlottesville, VA, USA.
⁶ Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, VA, USA.
⁷ Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA.
⁸ Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁹ Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Department of Medicine, Cardiovascular Division, University of Virginia, 1215 Lee Street, Charlottesville, VA, USA. asharma@virginia.edu.

Abstract

Venoarterial extracorporeal membrane oxygenation (ECMO) has been used to treat acute massive pulmonary embolism (PE) patients. However, the incremental benefit of ECMO to standard therapy remains unclear. Our meta-analysis objective is to compare in-hospital mortality in patients treated for acute massive PE with and without ECMO. The National Library of Medicine MEDLINE (USA), Web of Science, and PubMed databases from inception through October 2020 were searched. Screening identified 1002 published articles. Eleven eligible studies were identified, and 791 patients with acute massive PE were included, of whom 270 received ECMO and 521 did not. In-hospital mortality was not significantly different between patients treated with vs. without ECMO (OR = 1.24 [95% CI, 0.63-2.44], p = 0.54). However, these findings were limited by significant study heterogeneity. Additional research will be needed to clarify the role of ECMO in massive PE treatment. In-hospital mortality for patients with acute massive pulmonary embolism was not significantly different (OR of 1.24, p = 0.54) between those treated with and without venoarterial ECMO.

Keywords: Massive or high-risk pulmonary embolism; Venoarterial extracorporeal membrane oxygenation.

Publication types

Meta-Analysis
Review

MeSH terms

Extracorporeal Membrane Oxygenation* / adverse effects
Hospital Mortality
Humans
Pulmonary Embolism* / diagnosis
Pulmonary Embolism* / therapy
Retrospective Studies