FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3089476313> ?p ?o ?g. }

• W3089476313 endingPage "1901" @default.
• W3089476313 startingPage "1899" @default.
• W3089476313 abstract "EXTRACORPOREAL membrane oxygenation (ECMO) theoretically could be useful in patients with high-risk pulmonary embolism (PE). Current European Society of Cardiology guidelines give a low-grade recommendation for ECMO usage in patients with circulatory collapse or cardiac arrest, reporting that it may be considered (class IIb – level of evidence C) in combination with surgical embolectomy or catheter-based treatment.1Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603Crossref PubMed Scopus (1142) Google Scholar Caution is given regarding the use of ECMO in combination with systemic thrombolysis or as a stand-alone technique because of excessive risk of bleeding in one case and controversial efficacy in the other. The aim of the present study was to describe clinical characteristics and outcomes of high-risk acute PE patients treated with ECMO according to the first reperfusion strategy used (European Society of Cardiology guidelines–recommended strategy [surgical embolectomy or catheter-based treatment], systemic thrombolysis, or none). A systematic review of studies evaluating ECMO support in patients with acute PE was performed. PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched (until April 17, 2020). For this analysis, case reports, case series, and cohort studies clearly reporting patient-level data were included. Baseline clinical characteristics, clinical presentation details, reperfusion strategies, and in-hospital outcomes were extracted for each included patient and collected in a dedicated form. Patients were divided in the following three groups based on the first reperfusion strategy performed: surgical embolectomy or catheter-based treatment, systemic thrombolysis, or none. Continuous variables are presented as medians and interquartile ranges and were compared with the Kruskal-Wallis test; categorical variables are presented as numbers and percentages and were compared with the chi-square test. The effect of reperfusion strategy on in-hospital mortality was adjusted for relevant covariates by means of multivariate binary logistic regression. Statistical analyses were performed with STATA, Version 13.0 (Stata Corp, College Station, TX). A total of 74 articles reporting patient-level data for 140 patients were included in the final analysis (Supplementary Table 1). The first attempted reperfusion strategy was surgical embolectomy or catheter-based treatment in 59 patients (42.1%), whereas systemic thrombolysis was the first therapy used in 53 patients (37.9%) and no reperfusion therapy was implemented in 28 patients (20.0%). Cardiac arrest as indication for ECMO was significantly higher among patients who underwent systemic thrombolysis (81.1%) compared with patients who underwent surgical embolectomy or catheter-based treatment (57.6%) or who did not undergo reperfusion strategies (64.3%; p = 0.026). Rescue ECMO (bailout strategy) was more frequent in the systemic thrombolysis group (59.6%) compared with the surgical embolectomy or catheter-based treatment group (35.1%) and the no-reperfusion group (0.0%; p < 0.001); in contrast, immediate (upfront) ECMO support was more frequent in the no-reperfusion group (100%) compared with the surgical embolectomy or catheter-based treatment (64.9%) and systemic thrombolysis groups (40.4%; p < 0.001). Duration of ECMO support was significantly higher in the no-reperfusion group (p = 0.032). Details on reperfusion strategies adopted during hospital stay are reported in Table 1. Of note, surgical embolectomy and catheter-based treatment were performed as a secondary strategy (after systemic thrombolysis) in 15.1% and 11.3% of patients, respectively; systemic thrombolysis was performed as a secondary strategy (after surgical embolectomy or catheter-based treatment) in 1.7% of patients. In-hospital all-cause mortality, successful weaning from ECMO, and fatal bleeding were not significantly different among the three groups. A significantly higher rate of in-hospital major bleeding was observed in the systemic thrombolysis group (44.4%) compared with the surgical embolectomy or catheter-based treatment (22.9%) and no-reperfusion groups (14.8%; p = 0.013). After adjustment for age, cardiac arrest as ECMO indication, and use of immediate (upfront) ECMO, the first reperfusion strategy was not independently associated with in-hospital all-cause mortality (adjusted odds ratio 0.87, 95% confidence interval 0.29-2.60, p = 0.797 for systemic thrombolysis vs. surgical embolectomy or catheter-based treatment; adjusted odds ratio 0.87, 95% confidence interval 0.25-3.07, p = 0.825 for no-reperfusion vs. surgical embolectomy or catheter-based treatment).Table 1Baseline Characteristics, Clinical Presentation and ECMO Details, Reperfusion Therapy, and In-Hospital Clinical Outcomes According to the First Reperfusion Strategy UsedSurgical Embolectomy or Catheter-Based Treatment (n = 59)Systemic Thrombolysis (n = 53)No Reperfusion Strategy (n = 28)p-valueBaseline characteristics Age (y)50 (37-63)54 (37-65)52 (30-62)0.567 Female sex22/55 (43.6)30/45 (66.7)14/27 (51.9)0.070 Pregnancy5/53 (9.4)5/38 (13.2)1/24 (4.2)0.502 Smoking history2/53 (3.8)2/38 (5.3)1/24 (4.2)0.942 Oral contraceptives1/53 (1.9)1/38 (2.6)2/24 (3.5)0.339 Previous DVT or PE5/53 (9.4)1/38 (2.6)1/24 (4.2)0.370 Active cancer8/53 (15.1)6/38 (15.8)1/24 (4.2)0.347 Immobilization11/53 (20.8)7/38 (18.4)8/24 (33.3)0.357 Known thrombophilia4/53 (7.6)2/38 (5.3)1/24 (4.2)0.820 Recent surgery16/53 (30.2)13/38 (34.2)8/24 (33.3)0.913 Same hospitalization12/53 (22.6)6/38 (15.8)6/24 (25.0)0.624 Within 1 mo3/53 (5.7)6/38 (15.8)2/24 (8.3)0.262 Before 1 mo1/53 (1.9)1/38 (2.6)0/24 (0.0)0.738Clinical presentation and ECMO details ECMO for cardiac arrest34/59 (57.6)43/53 (81.1)18/28 (64.3)0.026 ECMO for cardiogenic shock25/59 (42.4)10/53 (18.9)10/28 (35.7)0.026 Immediate (upfront) ECMO37/57 (64.9)19/47 (40.4)25/25 (100.0)< 0.001 Rescue (bailout) ECMO20/57 (35.1)28/47 (59.6)0/25 (0.0)< 0.001 VA-ECMO59/59 (100.0)51/53 (96.2)25/28 (89.3)0.042 VV-ECMO3/59 (5.1)5/53 (9.4)4/28 (14.3)0.344 ECMO support duration (h)75 (36-144)48 (19-120)110 (72-144)0.032Reperfusion strategy Surgical embolectomy40/59 (67.8)8/53 (15.1)0/28 (0.0)< 0.001 Any catheter-based procedure21/59 (35.6)6/53 (11.3)0/28 (0.0)< 0.001 Transcatheter embolectomy12/59 (20.3)4/53 (7.6)0/28 (0.0)0.011 Ultrasound-assisted thrombolysis7/59 (11.9)1/53 (1.9)0/28 (0.0)0.026 Catheter-directed thrombolysis11/59 (18.6)2/53 (3.8)0/28 (0.0)0.004 Combined catheter-based technique7/59 (11.9)1/53 (1.9)0/28 (0.0)0.026 Systemic thrombolysis1/59 (1.7)53/53 (100.0)0/28 (0.0)< 0.001In-hospital clinical outcomes All-cause death15/59 (25.4)18/53 (34.0)6/28 (21.4)0.421 Successful ECMO weaning44/53 (83.0)34/39 (87.2)19/24 (79.2)0.697 Fatal bleeding2/48 (4.2)2/45 (4.4)0/27 (0.0)0.547 Major bleeding11/48 (22.9)20/45 (44.4)4/27 (14.8)0.013NOTE. Data are presented as median (interquartile range) or n/N (%).Abbreviations: DVT, deep vein thrombosis; ECMO, extracorporeal membrane oxygenation; PE, pulmonary embolism; VA, venoarterial; VV, venovenous. Open table in a new tab NOTE. Data are presented as median (interquartile range) or n/N (%). Abbreviations: DVT, deep vein thrombosis; ECMO, extracorporeal membrane oxygenation; PE, pulmonary embolism; VA, venoarterial; VV, venovenous. According to current European Society of Cardiology guidelines, ECMO may be considered in patients with high-risk acute PE presenting with shock or cardiac arrest, in combination with surgical embolectomy or catheter-based treatment.1Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603Crossref PubMed Scopus (1142) Google Scholar Considering the well-known ECMO-related complications and the potential effect on mortality of bleeding events,2Abrams D. Combes A. Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults.J Am Coll Cardiol. 2014; 63: 2769-2778Crossref PubMed Scopus (282) Google Scholar, 3Zangrillo A. Landoni G. Biondi-Zoccai G. et al.A meta-analysis of complications and mortality of extracorporeal membrane oxygenation.Crit Care Resusc. 2013; 15: 172-178PubMed Google Scholar, 4Aubron C. DePuydt J. Belon F. et al.Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation.Ann Intensive Care. 2016; 6: 97Crossref PubMed Scopus (118) Google Scholar, 5Harjola V.P. Mebazaa A. Čelutkienė J. et al.Contemporary management of acute right ventricular failure: A statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.Eur J Heart Fail. 2016; 18: 226-241Crossref PubMed Scopus (283) Google Scholar a careful balance between expected benefits and risks is necessary in daily practice before applying each reperfusion therapy in PE patients needing invasive cardiopulmonary support. Despite current European Society of Cardiology guidelines recommendations, our systematic review showed that in the realworld, many PE patients ultimately receive ECMO along with systemic thrombolysis (at the expense of higher bleeding risk) or without any reperfusion therapy, apparently with similar in-hospital survival. None. Download .docx (.08 MB) Help with docx files" @default.
• W3089476313 created "2020-10-08" @default.
• W3089476313 creator A5000595448 @default.
• W3089476313 creator A5006124487 @default.
• W3089476313 creator A5024136500 @default.
• W3089476313 creator A5037727117 @default.
• W3089476313 creator A5042043786 @default.
• W3089476313 creator A5048502162 @default.
• W3089476313 creator A5052382178 @default.
• W3089476313 creator A5054939706 @default.
• W3089476313 creator A5056781900 @default.
• W3089476313 creator A5057253215 @default.
• W3089476313 creator A5066995584 @default.
• W3089476313 creator A5076904266 @default.
• W3089476313 creator A5087088813 @default.
• W3089476313 date "2021-06-01" @default.
• W3089476313 modified "2023-09-25" @default.
• W3089476313 title "Reperfusion Strategies in Patients With High-Risk Acute Pulmonary Embolism Needing Extracorporeal Membrane Oxygenation Support: A Systematic Review" @default.
• W3089476313 cites W2057772670 @default.
• W3089476313 cites W2301761598 @default.
• W3089476313 cites W2529411187 @default.
• W3089476313 cites W2971121646 @default.
• W3089476313 doi "https://doi.org/10.1053/j.jvca.2020.09.129" @default.
• W3089476313 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/34756353" @default.
• W3089476313 hasPublicationYear "2021" @default.
• W3089476313 type Work @default.
• W3089476313 sameAs 3089476313 @default.
• W3089476313 citedByCount "0" @default.
• W3089476313 crossrefType "journal-article" @default.
• W3089476313 hasAuthorship W3089476313A5000595448 @default.
• W3089476313 hasAuthorship W3089476313A5006124487 @default.
• W3089476313 hasAuthorship W3089476313A5024136500 @default.
• W3089476313 hasAuthorship W3089476313A5037727117 @default.
• W3089476313 hasAuthorship W3089476313A5042043786 @default.
• W3089476313 hasAuthorship W3089476313A5048502162 @default.
• W3089476313 hasAuthorship W3089476313A5052382178 @default.
• W3089476313 hasAuthorship W3089476313A5054939706 @default.
• W3089476313 hasAuthorship W3089476313A5056781900 @default.
• W3089476313 hasAuthorship W3089476313A5057253215 @default.
• W3089476313 hasAuthorship W3089476313A5066995584 @default.
• W3089476313 hasAuthorship W3089476313A5076904266 @default.
• W3089476313 hasAuthorship W3089476313A5087088813 @default.
• W3089476313 hasBestOaLocation W30894763131 @default.
• W3089476313 hasConcept C126322002 @default.
• W3089476313 hasConcept C164705383 @default.
• W3089476313 hasConcept C177713679 @default.
• W3089476313 hasConcept C2776265017 @default.
• W3089476313 hasConcept C2776858399 @default.
• W3089476313 hasConcept C2778881276 @default.
• W3089476313 hasConcept C2779915274 @default.
• W3089476313 hasConcept C70289976 @default.
• W3089476313 hasConcept C71924100 @default.
• W3089476313 hasConceptScore W3089476313C126322002 @default.
• W3089476313 hasConceptScore W3089476313C164705383 @default.
• W3089476313 hasConceptScore W3089476313C177713679 @default.
• W3089476313 hasConceptScore W3089476313C2776265017 @default.
• W3089476313 hasConceptScore W3089476313C2776858399 @default.
• W3089476313 hasConceptScore W3089476313C2778881276 @default.
• W3089476313 hasConceptScore W3089476313C2779915274 @default.
• W3089476313 hasConceptScore W3089476313C70289976 @default.
• W3089476313 hasConceptScore W3089476313C71924100 @default.
• W3089476313 hasIssue "6" @default.
• W3089476313 hasLocation W30894763131 @default.
• W3089476313 hasLocation W30894763132 @default.
• W3089476313 hasOpenAccess W3089476313 @default.
• W3089476313 hasPrimaryLocation W30894763131 @default.
• W3089476313 hasRelatedWork W1983563312 @default.
• W3089476313 hasRelatedWork W2039544774 @default.
• W3089476313 hasRelatedWork W2092389795 @default.
• W3089476313 hasRelatedWork W2144897422 @default.
• W3089476313 hasRelatedWork W2223605038 @default.
• W3089476313 hasRelatedWork W2470262310 @default.
• W3089476313 hasRelatedWork W2580461368 @default.
• W3089476313 hasRelatedWork W2590308047 @default.
• W3089476313 hasRelatedWork W3152356813 @default.
• W3089476313 hasRelatedWork W3186068339 @default.
• W3089476313 hasVolume "35" @default.
• W3089476313 isParatext "false" @default.
• W3089476313 isRetracted "false" @default.
• W3089476313 magId "3089476313" @default.
• W3089476313 workType "article" @default.