Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism as Bridge to Therapy

Pulmonary Embolism (PE) is a common illness in western countries. The purpose of this study is to report the institutional experience with massive PE and Extracorporeal Membrane Oxygenation (ECMO) in inoperable patients on admission. A retrospective analysis using the institutional ECMO-registry including the time between 2006 and 2017 was performed. During the study period, 75 patients (n = 46 patients venoarterial [VA], n = 29 patients venovenous [VV]) were placed on ECMO for massive PE. The primary support for massive PE consists of VA; however, VV support can be applied as well in selected cases as this work demonstrates. In the VA group, more patients (38 vs. 83%, P = 0.001) required mechanical resuscitation whereas in the VV group a more aggressive ventilation before support was noted (e.g. minute ventilation: VA=8.8 +/- 3.7 L/min, VV=11.5 +/- 4.5 L/min, P = 0.01). Survival to discharge was similar in VV and VA patients (45 vs. 48%, P = 0.9). Patients who received additional therapeutic interventions after stabilization with ECMO - e.g. surgical thrombectomy - displayed a similar survival compared with those being only anticoagulated (44% vs. 49%, P = 0.40). ECMO is feasible for initial stabilization serving as a bridge to therapy in primarily inoperable patients with massive PE. The principal configuration of support is VA; however, VV can be applied as well in selected hemodynamically compromised cases under aggressive ventilation.