Survival after venoarterial extracorporeal membrane oxygenation for acute high-risk Pulmonary Embolism: A meta-analysis of comparative studies.

Abstract

Objective: The survival benefit of venoarterial Extracorporeal Membrane Oxygenation (ECMO) for the management of acute high-risk pulmonary embolism (PE) remains unclear. This meta-analysis combines data from comparative studies to assess the risk of mortality after ECMO vs standard care in the management of acute high-risk PE.

Methods: Databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched from 01^st January 2000 to 24^th March 2023 for comparative studies with at least 10 patients/group comparing ECMO vs standard treatment. PRISMA guidelines were followed for this review. We extracted mortality data and combined it to obtain the outcome as risk ratios (RR) with 95% confidence intervals (CI) in a random-effects model.

Results: Ten studies were included. Meta-analysis showed that the risk of early mortality was not significantly different between ECMO and non-ECMO groups (RR: 0.97 95% CI: 0.78, 1.19 I²=73%). No change in significance was noted on subgroup analysis based on study location, sample size, cardiac arrest, systemic thrombolysis, and surgical embolectomy.

Conclusion: Limited evidence derived from mostly retrospective studies riddled with selection bias suggests that ECMO may not offer additional survival benefits in high-risk PE.