Venoarterial Extracorporeal Life Support Use in Acute Pulmonary Embolism Shows Favorable Outcomes

Erik J Scott; Steven Young; Sarah J Ratcliffe; Xin-Qun Wang; J Hunter Mehaffey; Aditya Sharma; Peter Rycus; Joseph Tonna; Leora Yarboro; Ben Bryner; Michael Collins; Nicholas R Teman

doi:10.1016/j.athoracsur.2024.02.008

Venoarterial Extracorporeal Life Support Use in Acute Pulmonary Embolism Shows Favorable Outcomes

Ann Thorac Surg. 2024 Feb 14:S0003-4975(24)00109-7. doi: 10.1016/j.athoracsur.2024.02.008. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
² Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
³ Division of Vascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia.
⁴ Extracorporeal Life Support Organization, Ann Arbor, Michigan.
⁵ Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
⁶ Division of Cardiovascular Surgery, Department of Surgery, Duke University, Durham, North Carolina.
⁷ Department of Thoracic and Cardiovascular Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania.
⁸ Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: nrt4c@hscmail.mcc.virginia.edu.

PMID: 38360341
DOI: 10.1016/j.athoracsur.2024.02.008

Abstract

Background: Differences in outcomes by indication for venoarterial extracorporeal life support (VA-ECLS) are poorly described. We hypothesized that patients on VA-ECLS for acute pulmonary embolism (PE) have fewer complications and better survival than patients on VA-ECLS for other indications.

Methods: All patients ≥18 years on VA-ECLS from the Extracorporeal Life Support Organization global registry (2010-2019) were evaluated (n = 29,842). After excluding patients aged >79 years (n = 729) and those with incomplete indication data (n = 2530), patients were stratified by VA-ECLS indication for PE vs all other indications. The association between being discharged alive and each type of complication with VA-ECLS indication was assessed.

Results: Of 26,583 patients included in the analysis, 978 (3.7%) were on VA-ECLS for a primary diagnosis of acute PE. Acute PE patients were younger (53.1 vs 56.7 years, P < .001) and were more likely to be women (52.1% vs 32.3%, P < .001). Patients who underwent VA-ECLS for acute PE were 78% more likely to be discharged alive vs patients supported with VA-ECLS for other reasons (P < .001). Acute PE patients had fewer cardiovascular and renal complications (26.6% vs 38.0% and 31.1% vs 39.4%, respectively; adjusted P < .001). Acute PE patients had higher odds of having clots and mechanical complications (8.7% vs 7.9% and 16.7% vs 14.6%, respectively; adjusted P < .001).

Conclusions: Patients undergoing VA-ECLS for acute PE have higher odds of survival to hospital discharge compared with those supported for other indications. Additionally, VA-ECLS in this population is associated with fewer cardiovascular and renal complications but higher mechanical complications.