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VA ECMO for Massive PE + Cardiac Arrest

March 16, 2021

Written by Clay Smith

Spoon Feed
Patients with massive PE and cardiac arrest who received venoarterial (VA) ECMO had 61% survival to discharge.

Why does this matter?
Bo did an epic post on current management and controversies in treating PE. Use of VA ECMO is one of the areas where we need all the evidence we can get. Here is a bit more.

PE + VA ECMO for the win
This was a systematic review of 77 articles totaling 301 patients with PE and arrest who were placed on VA ECMO. Of these, 183 of 301 – 61% survived to discharge. Patients >65 years and those cannulated during cardiac arrest fared worse and had lower odds of survival. There was no difference in survival among those who received thrombolysis prior to cannulation; six had major bleeding but survived (n=51). Only 60 patients had neurological status documented, and 53 (88%) had a good outcome (CPC 1 – alert, able to work, none to mild deficits). But this rosy statistic should be viewed with caution, as most patients in the entire cohort did not record neurological outcome, just survival or not. Take home – in patients with massive PE, think VA ECMO early. If hemodynamically trending in the wrong direction, ECMO is a good option, preferably prior to arrest. Also, this study suggests that prior thrombolysis is not a contraindication to starting VA ECMO, although bleeding is still a very real risk.

Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review. Crit Care Med. 2021 Feb 15. doi: 10.1097/CCM.0000000000004828. Online ahead of print.

What are your thoughts?