Pulmonary embolectomy in high-risk acute pulmonary embolism: The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support

Meng Yu Wu, Yuan Chang Liu, Yuan His Tseng, Yu Sheng Chang, Pyng Jing Lin, Tzu I. Wu

研究成果: 雜誌貢獻文章

28 引文 (Scopus)

摘要

Objectives: To investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy. Materials and methods: This retrospective study included 25 consecutive patients of aPE treated with pulmonary embolectomy in a single institution between June 2005 and July 2012. All patients had high-risk aPE identified by computed tomographic angiography and were not suitable for thrombolytic therapy. High-risk aPE here was defined as aPE with (1) hemodynamic instability, (2) a pulmonary artery obstruction index (PAOI). ≥. 0.5, (3) a diameter ratio of right ventricle-to-left ventricle (RV-to-LV). ≥. 1.0, or (4) right heart thrombi. Once the eligibility was confirmed, a 3-staged therapeutic algorithm was adopted to perform an aggressive preoperative resuscitation, an expeditious pulmonary embolectomy with multidisciplinary postoperative care, and a thorough surveillance for recurrence. Results: Among the 25 patients, 24 had a PAOI. ≥. 0.5 and 23 had a RV-to-LV diameter ratio. ≥. 1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20% (n= 5). A preoperative CA (Odds ratio [OR]: 16, 95% confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95% CI: 2.1-501.3, p= 0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months (interquartile range: 8-29). Conclusion: Pulmonary embolectomy was an effective intervention of high-risk aPE. However, the occurrence of preoperative CA still carried a high mortality in spite of the assistance of ECLS.

原文英語
頁(從 - 到)1365-1370
頁數6
期刊Resuscitation
84
發行號10
DOIs
出版狀態已發佈 - 十月 2013

指紋

Embolectomy
Extracorporeal Membrane Oxygenation
Pulmonary Embolism
Lung
Heart Ventricles
Heart Arrest
Hospital Mortality
Pulmonary Artery
Thrombosis
Therapeutics
Odds Ratio
Confidence Intervals
Recurrence
Postoperative Care
Thrombolytic Therapy
Patient Rights
Resuscitation
Angiography
Retrospective Studies
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

引用此文

Pulmonary embolectomy in high-risk acute pulmonary embolism : The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support. / Wu, Meng Yu; Liu, Yuan Chang; Tseng, Yuan His; Chang, Yu Sheng; Lin, Pyng Jing; Wu, Tzu I.

於: Resuscitation, 卷 84, 編號 10, 10.2013, p. 1365-1370.

研究成果: 雜誌貢獻文章

Wu, Meng Yu ; Liu, Yuan Chang ; Tseng, Yuan His ; Chang, Yu Sheng ; Lin, Pyng Jing ; Wu, Tzu I. / Pulmonary embolectomy in high-risk acute pulmonary embolism : The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support. 於: Resuscitation. 2013 ; 卷 84, 編號 10. 頁 1365-1370.
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title = "Pulmonary embolectomy in high-risk acute pulmonary embolism: The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support",
abstract = "Objectives: To investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy. Materials and methods: This retrospective study included 25 consecutive patients of aPE treated with pulmonary embolectomy in a single institution between June 2005 and July 2012. All patients had high-risk aPE identified by computed tomographic angiography and were not suitable for thrombolytic therapy. High-risk aPE here was defined as aPE with (1) hemodynamic instability, (2) a pulmonary artery obstruction index (PAOI). ≥. 0.5, (3) a diameter ratio of right ventricle-to-left ventricle (RV-to-LV). ≥. 1.0, or (4) right heart thrombi. Once the eligibility was confirmed, a 3-staged therapeutic algorithm was adopted to perform an aggressive preoperative resuscitation, an expeditious pulmonary embolectomy with multidisciplinary postoperative care, and a thorough surveillance for recurrence. Results: Among the 25 patients, 24 had a PAOI. ≥. 0.5 and 23 had a RV-to-LV diameter ratio. ≥. 1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20{\%} (n= 5). A preoperative CA (Odds ratio [OR]: 16, 95{\%} confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95{\%} CI: 2.1-501.3, p= 0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months (interquartile range: 8-29). Conclusion: Pulmonary embolectomy was an effective intervention of high-risk aPE. However, the occurrence of preoperative CA still carried a high mortality in spite of the assistance of ECLS.",
keywords = "Acute pulmonary embolism, Cardiac arrest, Cardiogenic shock, Extracorporeal life support, Extracorporeal membrane oxygenation, Pulmonary embolectomy",
author = "Wu, {Meng Yu} and Liu, {Yuan Chang} and Tseng, {Yuan His} and Chang, {Yu Sheng} and Lin, {Pyng Jing} and Wu, {Tzu I.}",
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T2 - The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support

AU - Wu, Meng Yu

AU - Liu, Yuan Chang

AU - Tseng, Yuan His

AU - Chang, Yu Sheng

AU - Lin, Pyng Jing

AU - Wu, Tzu I.

PY - 2013/10

Y1 - 2013/10

N2 - Objectives: To investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy. Materials and methods: This retrospective study included 25 consecutive patients of aPE treated with pulmonary embolectomy in a single institution between June 2005 and July 2012. All patients had high-risk aPE identified by computed tomographic angiography and were not suitable for thrombolytic therapy. High-risk aPE here was defined as aPE with (1) hemodynamic instability, (2) a pulmonary artery obstruction index (PAOI). ≥. 0.5, (3) a diameter ratio of right ventricle-to-left ventricle (RV-to-LV). ≥. 1.0, or (4) right heart thrombi. Once the eligibility was confirmed, a 3-staged therapeutic algorithm was adopted to perform an aggressive preoperative resuscitation, an expeditious pulmonary embolectomy with multidisciplinary postoperative care, and a thorough surveillance for recurrence. Results: Among the 25 patients, 24 had a PAOI. ≥. 0.5 and 23 had a RV-to-LV diameter ratio. ≥. 1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20% (n= 5). A preoperative CA (Odds ratio [OR]: 16, 95% confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95% CI: 2.1-501.3, p= 0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months (interquartile range: 8-29). Conclusion: Pulmonary embolectomy was an effective intervention of high-risk aPE. However, the occurrence of preoperative CA still carried a high mortality in spite of the assistance of ECLS.

AB - Objectives: To investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy. Materials and methods: This retrospective study included 25 consecutive patients of aPE treated with pulmonary embolectomy in a single institution between June 2005 and July 2012. All patients had high-risk aPE identified by computed tomographic angiography and were not suitable for thrombolytic therapy. High-risk aPE here was defined as aPE with (1) hemodynamic instability, (2) a pulmonary artery obstruction index (PAOI). ≥. 0.5, (3) a diameter ratio of right ventricle-to-left ventricle (RV-to-LV). ≥. 1.0, or (4) right heart thrombi. Once the eligibility was confirmed, a 3-staged therapeutic algorithm was adopted to perform an aggressive preoperative resuscitation, an expeditious pulmonary embolectomy with multidisciplinary postoperative care, and a thorough surveillance for recurrence. Results: Among the 25 patients, 24 had a PAOI. ≥. 0.5 and 23 had a RV-to-LV diameter ratio. ≥. 1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20% (n= 5). A preoperative CA (Odds ratio [OR]: 16, 95% confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95% CI: 2.1-501.3, p= 0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months (interquartile range: 8-29). Conclusion: Pulmonary embolectomy was an effective intervention of high-risk aPE. However, the occurrence of preoperative CA still carried a high mortality in spite of the assistance of ECLS.

KW - Acute pulmonary embolism

KW - Cardiac arrest

KW - Cardiogenic shock

KW - Extracorporeal life support

KW - Extracorporeal membrane oxygenation

KW - Pulmonary embolectomy

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