21: Characteristics of Survivors of High-Risk Pulmonary Embolism Receiving Veno-Arterial Extracorporeal Membrane Oxygenation: A Meta-Analysis
Recommended Citation
Buda K, Baldetti L, Garcia S, Basir MB, Gage A, Van Hove C, Bennett M, Melamed R, Megaly M, Skeik N, Hryniewicz K. 21: Characteristics of Survivors of High-Risk Pulmonary Embolism Receiving Veno-Arterial Extracorporeal Membrane Oxygenation: A Meta-Analysis. ASAIO J 2025; 71(Supplement 4):3.
Document Type
Conference Proceeding
Publication Date
9-1-2025
Publication Title
ASAIO J
Keywords
lactic acid, article, clinical outcome, human, in-hospital mortality, lactate blood level, lung embolism, meta analysis, mortality rate, resuscitation, sonothrombolysis, survival, survivor, systematic review, systemic thrombolysis, treatment contraindication, veno-arterial ECMO
Abstract
Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used for pulmonary embolism (PE). Predictors of survival in this population are poorly understood. Objectives: To evaluate the outcomes of patients with high-risk PE supported with V-A ECMO and identify characteristics differentiating survivors from non-survivors. Methods: An updated systematic review and meta-analysis was conducted of observational studies involving patients with high-risk PE supported with V-A ECMO. Results: Among 50 observational studies comprising 1,125 patients with high-risk PE treated with V-A ECMO, 63% had cardiac arrest, and 48.8% had contraindications to thrombolysis. The most common reperfusion therapies were ultrasound-guided thrombolysis (44%) and systemic thrombolysis (38.9%). The pooled in-hospital mortality was 40.6% (95% CI 33.4% - 47.8%), while the 30-day mortality was 44.4% (95% CI 34.3-54.5). Among studies reporting outcomes as a function of survival status (n=29, 646 patients), survivors (n=327) were younger and less frequently presented with cardiac arrest (64% vs. 83%, p<0.001) than non-survivors (n=319). Survivors had shorter durations of cardiopulmonary resuscitation (34.3 ± 29.4 vs. 55.4 ± 33.0 minutes, p<0.001) and lower lactate levels (7.2 ± 6.1 vs. 13.1 ± 7.1 mmol/L, p<0.001). Among survivors of high-risk PE supported with V-A ECMO, 84.4% had neurologically intact survival. Conclusion: Survivors of high-risk PE supported with V-A ECMO have a high rate of neurologically intact survival. The substantial heterogeneity in patient populations and treatment strategies underscores the need for standardized protocols and prospective studies to refine V-A ECMO selection criteria and timing in this critically ill population.
Volume
71
Issue
Supplement 4
First Page
3
