Screening pulmonary angiogram and the effect on anticoagulation strategies in severe respiratory failure patients on venovenous extracorporeal membrane oxygenation.
acute respiratory distress syndrome
anticoagulants
extracorporeal membrane oxygenation
pulmonary embolism
respiratory insufficiency
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
04
05
2019
accepted:
16
09
2019
pubmed:
21
9
2019
medline:
15
5
2021
entrez:
21
9
2019
Statut:
ppublish
Résumé
Venovenous extracorporeal membrane oxygenation in the treatment of severe respiratory failure in adults continues to increase with survival improving; however, it remains associated with serious complications. The aim of this study was to evaluate the prevalence of pulmonary embolism (PE) in patients with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV ECMO) and in those managed with conventional mechanical ventilation. A single-center, observational cohort, retrospective study was undertaken of patients with severe respiratory failure managed with conventional ventilation or requiring ECMO in a tertiary referral university teaching hospital. We identified 343 patients with severe respiratory failure between January 2014 and December 2017. VV ECMO was used to support 290 patients and 53 were managed by conventional mechanical ventilation. The prevalence of PE was 9.6% (33/343), of which those supported with VV ECMO was 10% (29/290) and conventional ventilation 7.5% (4/53). There was no difference in survival rates between cohorts with PE versus no PE (ECMO survival to discharge P = .56; conventional ventilation survival to discharge P = .21). The prevalence of pulmonary embolism in severe respiratory failure has important clinical implications for both short and long-term anticoagulation strategies. Routine screening pulmonary angiogram is warranted in this cohort.
Sections du résumé
BACKGROUND
Venovenous extracorporeal membrane oxygenation in the treatment of severe respiratory failure in adults continues to increase with survival improving; however, it remains associated with serious complications.
OBJECTIVE
The aim of this study was to evaluate the prevalence of pulmonary embolism (PE) in patients with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV ECMO) and in those managed with conventional mechanical ventilation.
METHODS
A single-center, observational cohort, retrospective study was undertaken of patients with severe respiratory failure managed with conventional ventilation or requiring ECMO in a tertiary referral university teaching hospital.
RESULTS
We identified 343 patients with severe respiratory failure between January 2014 and December 2017. VV ECMO was used to support 290 patients and 53 were managed by conventional mechanical ventilation. The prevalence of PE was 9.6% (33/343), of which those supported with VV ECMO was 10% (29/290) and conventional ventilation 7.5% (4/53). There was no difference in survival rates between cohorts with PE versus no PE (ECMO survival to discharge P = .56; conventional ventilation survival to discharge P = .21).
CONCLUSIONS
The prevalence of pulmonary embolism in severe respiratory failure has important clinical implications for both short and long-term anticoagulation strategies. Routine screening pulmonary angiogram is warranted in this cohort.
Identifiants
pubmed: 31539196
doi: 10.1111/jth.14640
pii: S1538-7836(22)01571-9
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-221Informations de copyright
© 2019 International Society on Thrombosis and Haemostasis.
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