Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2.

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE Journal of Intensive Care Pub Date : 2024-11-05 DOI:10.1186/s40560-024-00755-x
Kensuke Takabayashi, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Takeshi Inoue, Shunsuke Usami, Po-Min Chen, Kiyonori Togi, Norimichi Koitabashi, Seiichi Hiramori, Kosuke Doi, Hiroshi Mabuchi, Yoshiaki Tsuyuki, Koichiro Murata, Hisato Nakai, Daisuke Sueta, Wataru Shioyama, Tomohiro Dohke, Ryusuke Nishikawa, Koh Ono, Takeshi Kimura
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) might be required as a treatment option in patients with critical pulmonary embolism (PE). However, the clinical features and outcomes of the use of ECMO for critical acute PE are still limited. The present study aimed to clarify the clinical characteristics, management strategies and outcomes of patients with acute PE requiring ECMO in the current era using data from a large-scale observational database.

Methods: We analyzed the data of the COMMAND VTE Registry-2: a physician-initiated, multicenter, retrospective cohort study enrolling consecutive patients with acute symptomatic venous thromboembolism (VTE). Among 2035 patients with acute symptomatic PE, there were 76 patients (3.7%) requiring ECMO.

Results: Overall, the mean age was 58.4 years, and 34 patients (44.7%) were men. Cardiac arrest or circulatory collapse at diagnosis was reported in 67 patients (88.2%). The 30-day incidence of all-cause death was 30.3%, which were all PE-related deaths. The 30-day incidence of major bleeding was 54.0%, and the vast majority of bleedings were procedure site-related bleeding events and surgery-related bleeding (22.4%). The 30-day incidence of all-cause death was 6.3% in 16 patients with surgical intervention, 43.8% in 16 patients with catheter intervention, 25.0% in 16 patients with thrombolytic therapy, and 39.3% in 28 patients with anticoagulation only.

Conclusions: The current large real-world VTE registry in Japan revealed clinical features and outcomes of critical acute PE requiring ECMO in the current era, which suggested several unmet needs for future clinical trials.

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需要体外膜肺氧合的危重急性肺栓塞患者的临床特征和短期疗效:来自 COMMAND VTE 注册-2。
背景:危重肺栓塞(PE)患者可能需要使用体外膜肺氧合(ECMO)治疗。然而,对危重急性肺栓塞患者使用 ECMO 的临床特征和疗效仍然有限。本研究旨在利用大规模观察性数据库的数据,阐明当前需要使用 ECMO 的急性 PE 患者的临床特征、管理策略和预后:我们分析了 COMMAND VTE Registry-2 的数据:这是一项由医生发起的多中心回顾性队列研究,连续纳入了急性症状性静脉血栓栓塞症(VTE)患者。在 2035 名急性症状性 PE 患者中,有 76 名患者(3.7%)需要接受 ECMO:总的来说,平均年龄为 58.4 岁,34 名患者(44.7%)为男性。67名患者(88.2%)在确诊时出现心脏骤停或循环衰竭。30天内全因死亡发生率为30.3%,均为与PE相关的死亡。30天内大出血的发生率为54.0%,绝大多数出血为手术部位相关出血事件和手术相关出血(22.4%)。16名接受手术干预的患者30天内全因死亡的发生率为6.3%,16名接受导管干预的患者为43.8%,16名接受溶栓治疗的患者为25.0%,28名仅接受抗凝治疗的患者为39.3%:目前日本的大型真实世界 VTE 登记揭示了当前需要 ECMO 的危重急性 PE 的临床特征和预后,为未来的临床试验提出了一些尚未满足的需求。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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