Long-Term Follow-up and Quality of Life in Patients Receiving Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism and Cardiogenic Shock

Objectives: Since the renewal of guidelines in 2019, extracorporeal life support is recommended as a salvage strategy for treatment of massive pulmonary embolism (PE). However, data on long-term survival, quality of life as well as cardiac and lung function after ECMO treatment in PE is lacking.

Methods: Follow-up was performed in 119 patients with PE treated with ECMO between 2006 and 2020. Data were obtained from the survivors by phone contact followed by personal interviews, a “quality-of-life” analysis using the EQ 5D5L questionnaire, echocardiography, lung function analysis, or ergospirometry.

Result: Mean age of the cohort was 50.9 ± 14.7 years (58% male) with an ECMO support of 6.6 days. 45.4% (n = 54) survived to discharge, 8 patients died during a mean follow-up time of 1,393 ± 1,228 days. Survivors had a longer ICU and overall hospital stay (22 ± 14 days vs. 13 ± 20 days, p = 0.01; 30 ± 22 d vs. 14 ± 20, p = 0). Lactate level (120 ± 65 mg/dL vs. 61 ± 48 mg/dL, p = 0.001) and epinephrine dose (1.3 ± 2 mg/h vs. 0.6 ± 1.3 mg/h, p = 0.04) pre-ECMO were higher in non-survivors, whereas MAP and pH levels were lower compared with survivors (46 ± 17 mm Hg vs. 60 ± 15 mm Hg, p = 0; 7.1 ± 0.2 vs. 7.2 ± 0.1, p = 0.001). CPR and hemodialysis were associated with a higher mortality (70 vs. 43%, p = 0.005; 73 vs. 52%, p = 0.02). Detailed data was obtained from 6 patients after a mean follow-up time of 2,406 days. Compared with German reference population, quality of life was reduced (Eq. 5D5L Index 0.57 ± 0.41 vs. 0.908; EQ VAS 67.5 ± 21 vs. 78.5%). All patients (n = 6) retired from work, 66% (n = 4) could handle their usual activities. None of the patients presented with groin problems at cannulation site or recurrence of PE, one patient experienced a deep lower leg thrombosis. Left-ventricular ejection fraction was 61 ± 5%. There were no signs of reduced RV function or pulmonary hypertension (RVEDD 30 ± 4 mm; TAPSE 24 ± 4 mm). None of the patients were severely limited in their cardiopulmonary performance (peak vO₂ 14 ± 4 mL/min/kg, 72 ± 17% of predicted) or showed signs of pulmonary obstruction or restriction (FEV₁/FVC ratio 79 ± 5%; VC 3 ± 0.5 L).

Conclusion: Though ECMO treatment in PE has a high mortality, surviving patients seem to recover well with an acceptable quality of life and no severe cardiopulmonary limitations. CPR, CVVHD, elevated lactate and epinephrine levels contribute to a higher mortality rate, as well as low MAP and pH level prior to ECMO.

 

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Artikel online veröffentlicht:
19. Februar 2021