Selected studies on patients with acute, high-risk PE on ECMO support
| Study, year . | Patients, n* . | Cardiac arrest, n (%) . | Thrombolytic therapy, n (%) . | Mechanical removal of PE, n . | Duration of ECMO, average (range) . | Complications/ Bleeding . | Survival, % . |
|---|---|---|---|---|---|---|---|
| Kawahito et al., 200038 | 7 | 4 (71%) | 7 (100%) | 3 surgical embolectomies | 18-168 hours | None | 57 |
| Maggio et al., 200739 | 21 (19 VA ECMO and 2 VV ECMO) | 8 (38%) | 6 (29%) | 4 surgical and 7 suction embolectomies | 5.4 days (5 hours to 12.5 days) | 4 ICH, 1 multiorgan failure | 62 |
| Sakuma et al., 200940 | 193 | NR | 120 (62%), 20 patients got only heparin with ECMO | 68 (35%) surgical embolectomies, 46 (24%) catheter therapy | NR | ICH or infarction in 24% | 73 |
| Malekan et al., 2012 | 4 | NR | None, heparin with ECMO for all | 1 suction pulmonary embolectomy | 5.3 days | None | 100 |
| Munakata et al., 201225 | 10 | 9 (90%) | 10 (100%) | 9 suction embolectomies | NR | 2 major bleeding | 70 |
| Omar et al., 201341 | 4 | 2 (50%) | 1 (25%) | 1 suction and 2 surgical pulmonary embolectomies | NR | NR | 25 |
| Maj et al., 201442 | 6 | 6 (100%) | 4 (66%) | 1 surgical embolectomy, 2 CDT | 4.5 days (1 to 11 days) | 3 major bleeding | 33 |
| Cho et al.,201643 | 13 | NR | 2 (15%) | 11 surgical embolectomies | NR | NR | NR |
| Dolmatova et al.,201731 | 5 | 4 (80%) | None | 1 surgical embolectomy, 2 CDT | NR | NR | 60 |
| Corsi et al., 201727 | 17 | 15 (88%) | 8 (47%) | 1 suction and 1 surgical embolectomy | 4 (1 to 12) days | 15 major bleeding | 47 |
| George et al., 201844 | 32 | 15 (47%) | 5 (16%) | 11 CDT, 2 surgical embolectomies, 4 aspiration thrombectomies | NR | 11 any bleeding, 1 ICH | 53 |
| Swol et al., 201830 | 5 | 5 (100%) | 3 (60%) | 1 surgical pulmonary embolectomy | 48.6 hours (1.5 to 100) | 2 major bleeding | 40 |
| Moon et al., 201828 | 14 | 11 (79%) | 1 (7%) | 1 surgical pulmonary embolectomy | 7.9 days | 7 moderate to severe bleeding | 36 |
| Meneveau et al., 201835 | 52 | 39 (75%) | 20 (38%) | 17 surgical embolectomies, 18 anticoagulation alone with ECMO | NR | 20 major bleeding | 38% at 30 days, 35% at 90 days |
| Pasrija et al., 201834 | 20 | 5 (25%) | 7 (35%) | 1 (5%) CDT, 11 (55%) surgical embolectomies, 8 (40%) anticoagulation alone with ECMO | 5.1 days (3.7 to 6.7) | 2 bleeding requiring transfusion | 95 |
| Pasrija et al., 201829 | Protocol: 27 | 6 (22%) | 6 (22%) | 12 surgical embolectomies, 15 anticoagulation alone with ECMO | 5.8 days (4.3 to 6.7) | 4 bleeding (15%) | 96% at 1 year |
| Historic controls: 6/27 | 6 | NR | 6 surgical embolectomy | NR | 3 bleeding (50%) | 73 | |
| Al-Bawardy et al., 201945 | 13 | 13 (100%) | 8 (62%) | 3 (23%) CDT, 4 (31%) surgical embolectomy | 5.5 days (2 to 18) | 7 (54%) major bleeding | 69% at 30d, 46% at 1 year |
| Ius et al., 201946 | 36 | 15 (42%) | 19 systemic or CDT | 20 surgical embolectomy, 16 anticoagulation with ECMO | Variable | 1 leg ischemia, 2 bleeding | 67 |
| Kjaergaard et al., 201947 | 22 | 22 (100%) | 12 (55%) | 5 surgical thrombectomy, 1 suction thrombectomy, 10 anticoagulation with ECMO | 0.5 to 168 hours | 2 intrabdominal bleeds, 2 ICH | 55% at 1 month and 45% at 1 year |
| Oh et al., 201948 | 16 | 12 (75%) | 7 (43.8%) | 9 (56.3%) | 1.5 days (0 to 4.5) | Bleeding in 9 patients | 67 |
| Kmiec et al., 202037 | 75 (46 VA ECMO, 29 VV ECMO) | 49 (65%) | 30 (40%) | 28 anticoagulation alone with ECMO, 8 interventional thrombectomies, 10 surgical embolectomies | NR | NR | 47 |
| Guliani et al., 202032 | 17 | 10 (59%) | None | 3 CDT | 86 hours | Bleeding in 4 patients | 76 |
| Ghoreishi et al., 202033 | 41 | 12 (29%) | 10 (24%) | 11 surgical embolectomies, 30 anticoagulation with ECMO | 6 days | NR | 98 |
| Study, year . | Patients, n* . | Cardiac arrest, n (%) . | Thrombolytic therapy, n (%) . | Mechanical removal of PE, n . | Duration of ECMO, average (range) . | Complications/ Bleeding . | Survival, % . |
|---|---|---|---|---|---|---|---|
| Kawahito et al., 200038 | 7 | 4 (71%) | 7 (100%) | 3 surgical embolectomies | 18-168 hours | None | 57 |
| Maggio et al., 200739 | 21 (19 VA ECMO and 2 VV ECMO) | 8 (38%) | 6 (29%) | 4 surgical and 7 suction embolectomies | 5.4 days (5 hours to 12.5 days) | 4 ICH, 1 multiorgan failure | 62 |
| Sakuma et al., 200940 | 193 | NR | 120 (62%), 20 patients got only heparin with ECMO | 68 (35%) surgical embolectomies, 46 (24%) catheter therapy | NR | ICH or infarction in 24% | 73 |
| Malekan et al., 2012 | 4 | NR | None, heparin with ECMO for all | 1 suction pulmonary embolectomy | 5.3 days | None | 100 |
| Munakata et al., 201225 | 10 | 9 (90%) | 10 (100%) | 9 suction embolectomies | NR | 2 major bleeding | 70 |
| Omar et al., 201341 | 4 | 2 (50%) | 1 (25%) | 1 suction and 2 surgical pulmonary embolectomies | NR | NR | 25 |
| Maj et al., 201442 | 6 | 6 (100%) | 4 (66%) | 1 surgical embolectomy, 2 CDT | 4.5 days (1 to 11 days) | 3 major bleeding | 33 |
| Cho et al.,201643 | 13 | NR | 2 (15%) | 11 surgical embolectomies | NR | NR | NR |
| Dolmatova et al.,201731 | 5 | 4 (80%) | None | 1 surgical embolectomy, 2 CDT | NR | NR | 60 |
| Corsi et al., 201727 | 17 | 15 (88%) | 8 (47%) | 1 suction and 1 surgical embolectomy | 4 (1 to 12) days | 15 major bleeding | 47 |
| George et al., 201844 | 32 | 15 (47%) | 5 (16%) | 11 CDT, 2 surgical embolectomies, 4 aspiration thrombectomies | NR | 11 any bleeding, 1 ICH | 53 |
| Swol et al., 201830 | 5 | 5 (100%) | 3 (60%) | 1 surgical pulmonary embolectomy | 48.6 hours (1.5 to 100) | 2 major bleeding | 40 |
| Moon et al., 201828 | 14 | 11 (79%) | 1 (7%) | 1 surgical pulmonary embolectomy | 7.9 days | 7 moderate to severe bleeding | 36 |
| Meneveau et al., 201835 | 52 | 39 (75%) | 20 (38%) | 17 surgical embolectomies, 18 anticoagulation alone with ECMO | NR | 20 major bleeding | 38% at 30 days, 35% at 90 days |
| Pasrija et al., 201834 | 20 | 5 (25%) | 7 (35%) | 1 (5%) CDT, 11 (55%) surgical embolectomies, 8 (40%) anticoagulation alone with ECMO | 5.1 days (3.7 to 6.7) | 2 bleeding requiring transfusion | 95 |
| Pasrija et al., 201829 | Protocol: 27 | 6 (22%) | 6 (22%) | 12 surgical embolectomies, 15 anticoagulation alone with ECMO | 5.8 days (4.3 to 6.7) | 4 bleeding (15%) | 96% at 1 year |
| Historic controls: 6/27 | 6 | NR | 6 surgical embolectomy | NR | 3 bleeding (50%) | 73 | |
| Al-Bawardy et al., 201945 | 13 | 13 (100%) | 8 (62%) | 3 (23%) CDT, 4 (31%) surgical embolectomy | 5.5 days (2 to 18) | 7 (54%) major bleeding | 69% at 30d, 46% at 1 year |
| Ius et al., 201946 | 36 | 15 (42%) | 19 systemic or CDT | 20 surgical embolectomy, 16 anticoagulation with ECMO | Variable | 1 leg ischemia, 2 bleeding | 67 |
| Kjaergaard et al., 201947 | 22 | 22 (100%) | 12 (55%) | 5 surgical thrombectomy, 1 suction thrombectomy, 10 anticoagulation with ECMO | 0.5 to 168 hours | 2 intrabdominal bleeds, 2 ICH | 55% at 1 month and 45% at 1 year |
| Oh et al., 201948 | 16 | 12 (75%) | 7 (43.8%) | 9 (56.3%) | 1.5 days (0 to 4.5) | Bleeding in 9 patients | 67 |
| Kmiec et al., 202037 | 75 (46 VA ECMO, 29 VV ECMO) | 49 (65%) | 30 (40%) | 28 anticoagulation alone with ECMO, 8 interventional thrombectomies, 10 surgical embolectomies | NR | NR | 47 |
| Guliani et al., 202032 | 17 | 10 (59%) | None | 3 CDT | 86 hours | Bleeding in 4 patients | 76 |
| Ghoreishi et al., 202033 | 41 | 12 (29%) | 10 (24%) | 11 surgical embolectomies, 30 anticoagulation with ECMO | 6 days | NR | 98 |
Abbreviations: VV ECMO, veno-venous ECMO; VA ECMO, veno-arterial ECMO; ICH, intracranial hemorrhage; NR, not reported; CDT, catheter directed treatment.
*Indicates VA ECMO support unless indicated.