Patients with massive pulmonary emboli (PE) triaged and treated using a highly protocolized approach with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) had higher 1-year survival rates than those treated using a conventional treatment approach, according to a recent study published in the Journal of Thoracic and Cardiovascular Surgery.
Records from patients presenting with massive PE in the Society of Thoracic Surgeons database were reviewed and categorized into either those who were treated using a conventional approach or those who were treated using a highly protocolized approach with VA-ECMO. The primary outcome of 1-year survival rates was then compared between groups.
Among the 56 participants in the study, 27 were categorized into the historical approach, and 29 into the protocolized treatment approach. In the protocol approach group, all patients were placed on VA-ECMO as the primary planned intervention, with a median duration of 5.8 days.
“In the historical control group, patients were placed on VA-ECMO as a rapid bridge to the primary planned intervention of surgical pulmonary embolectomy, with a median duration of 1.0 days,” the authors wrote. “In-hospital survival was 97% in the protocol approach and 82% in the historical control,” they add. One-year survival rates were 96% in the protocol approach vs 73% in the historical control.
The study authors wrote, “This study demonstrates that a protocolized approach, involving the aggressive institution of VA-ECMO, may reduce mortality compared to an early, aggressive surgical approach for massive PE.”
Pasrija C, Shah A, George P, et al. Triage and optimization: a new paradigm in the treatment of massive pulmonary embolism [published online April 7, 2018]. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2018.02.107