Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study.
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Levy David, Petit Matthieu, Assouline Benjamin, Dietl Alexander, Lebreton Guillaume, Giraud Raphaël, Ihle Joshua, Masi Paul, Newman Sally, Condella Anna, Riera Jordi, Pierrot Marc, Mansour Alexandre, Ohshimo Shinichiro, Thellier Lise, Donker Dirk W, Besnard Celine, Vennier Alice, Winiszewski Hadrien, Tavazzi Guido, Taylor Jonathan, Dessajan Julien, Lepper Philipp M, Ng Pauline Yeung, Chico Juan I, Guervilly Christophe, Pot Louis, Dauwe Dieter, Fortuna Philip, Taccone Fabio Silvio, Compagnon Baptiste, Jung Jae-Seung, Ltaief Zied, Roncon-Albuquerque Roberto, Denormandie Pierre, Giani Marco, Duburcq Thibault, Grasselli Giacomo, Nougué Hélène, Werquin Adrien, Sanchez Olivier, Beurton Antoine, Balik Martin, Jungling Marie, Heinrich Maria, Mueller Thomas, Combes Alain, Schmidt Matthieu, CATAPULTE Investigator Group
Аннотация
METHODS: This retrospective international study included adult patients treated with VA-ECMO for high-risk PE at 39 ECMO centers (2014-2024). Early mechanical reperfusion was defined as catheter-directed therapy or surgical embolectomy within 48 hours of ECMO initiation. Patients dying within 12 hours or receiving delayed reperfusion were excluded. The primary outcome was 90-day mortality, assessed using propensity-matched groups.
MEASUREMENTS AND MAIN RESULTS: Among 492 patients on VA-ECMO (median age, 53 years), 69% had cardiac arrest, and 28% received early mechanical reperfusion. After propensity matching, 137 patients were compared in each group. Ninety-day mortality was 32% with early mechanical reperfusion on ECMO versus 39% with ECMO stand-alone (HR, 0.68 [95% CI, 0.45-1.03]; P = .07). Overall, ECMO duration and weaning rates were similar; however, early mechanical reperfusion improved ECMO weaning in patients without prior thrombolysis (subdistribution HR, 1.56 [95% CI, 1.03-2.36]; P = .04). Bleeding occurred in 50% of patients, with no significant difference between groups.
CONCLUSIONS: In this large international cohort of patients with high-risk PE on VA-ECMO, early mechanical reperfusion therapy was not associated with a reduction in 90-day mortality or ECMO duration. These findings may support a stepwise, individualized approach favoring initial ECMO stand-alone support, although a certain clinical benefit from early mechanical reperfusion in selected patients cannot be excluded.