Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation? - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Journal of Clinical Medicine Année : 2022

Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?

Benjamin Assouline
  • Fonction : Auteur
Marie Assouline-Reinmann
  • Fonction : Auteur
Raphaël Giraud
David Levy
  • Fonction : Auteur
Ouriel Saura
  • Fonction : Auteur
Karim Bendjelid
Matthieu Schmidt

Résumé

Pulmonary embolism (PE) is a common disease with an annual incidence rate ranging from 39–115 per 100,000 inhabitants. It is one of the leading causes of cardiovascular mortality in the USA and Europe. While the clinical presentation and severity may vary, it is a life-threatening condition in its most severe form, defined as high-risk or massive PE. Therapeutic options in high-risk PE are limited. Current guidelines recommend the use of systemic thrombolytic therapy as first-line therapy (Level Ib). However, this treatment has important drawbacks including bleeding complications, limited efficacy in patients with recurrent PE or cardiac arrest, and formal contraindications. In this context, the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the management of high-risk PE has increased worldwide in the last decade. Strategies, including VA-ECMO as a stand-alone therapy or as a bridge to alternative reperfusion therapies, are associated with acceptable outcomes, especially if implemented before cardiac arrest. Nonetheless, the level of evidence supporting ECMO and alternative reperfusion therapies is low. The optimal management of high-risk PE patients will remain controversial until the realization of a prospective randomized trial comparing those cited strategies to systemic thrombolysis.

Dates et versions

hal-03995532 , version 1 (18-02-2023)

Identifiants

Citer

Benjamin Assouline, Marie Assouline-Reinmann, Raphaël Giraud, David Levy, Ouriel Saura, et al.. Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?. Journal of Clinical Medicine, 2022, 11 (16), pp.4734. ⟨10.3390/jcm11164734⟩. ⟨hal-03995532⟩
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