Use of extracorporeal membrane oxygenation in high-risk acute pulmonary embolism.

Purpose ExtraCorporeal Membrane Oxygenation (ECMO) represents a therapeutic option for cardiopulmonary support in patients with high-risk pulmonary embolism (PE); however, no definite consensus exists on ECMO use in high-risk PE. Hence, we aim to provide insights on its real-world use pooling together all available published experiences. Methods We performed a systematic review and pooled analysis of all published studies (up to April 17, 2020) investigating ECMO support in high-risk PE. All studies including at least 4 patients were collectively analyzed. Study outcomes were early all-cause death (primary endpoint) and relevant in-hospital adverse events. Results A total of 21 studies were included in the pooled analysis (n=635 patients). In this population (mean age 47.8 ± 17.3 years, 44.5% females) ECMO was indicated for cardiac arrest in 62.3% and immediate ECMO support was pursued in 61.9% of patients. Adjunctive reperfusion therapies were implemented in 57.0% of patients. Pooled estimate rate of early all-cause mortality was 41.1% (95% CI 27.7-54.5%). The most common in-hospital adverse event was major bleeding, with an estimated rate of 28.6% (95%CI 21.0-36.3%). At meta-regression analyses, no significant impact of multiple covariates on primary endpoint was found. Conclusions In this systematic review on patients who received ECMO for high-risk PE, pooled all-cause mortality was 41.1%. Principal indication for ECMO was cardiac arrest, cannulation was chiefly performed at presentation, and major bleeding was the most common complication.