Table_3_Efficacy and Safety of Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of High-Risk Pulmonary Embolism: A Retrospective Cohort Study.docx

ObjectivesVeno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly used to treat high-risk pulmonary embolism (PE). However, its efficacy and safety remain uncertain. This retrospective cohort study aimed to determine whether ECMO could improve the clinical outcomes of patients with high-risk PE.
MethodsForty patients with high-risk PE, who were admitted to Kaohsiung Chang Gung Memorial Hospital between January 2012 and December 2019, were included in this study. Demographic data and clinical outcomes were compared between patients treated without ECMO (non-ECMO group) and those treated with ECMO (ECMO group). Appropriate statistical tools were used to compare variables between groups and the survival was analyzed using the Kaplan–Meier method.
ResultsThe overall in-hospital mortality rate was 55%, in which 65% (26/40) of patients presented with cardiac arrest with a mortality rate of 77%, which was higher than that of patients without cardiac arrest (14%). There was no significant difference in major complications and in-hospital mortality between the non-ECMO and ECMO groups. However, in subgroup analysis, compared with patients treated without ECMO, earlier ECMO treatment was associated with a reduced risk of cardiac arrest (P = 0.023) and lower in-hospital mortality (P = 0.036). A log-rank test showed a significantly higher cumulative overall survival in the earlier ECMO treatment group (P = 0.033).
ConclusionsIn this retrospective cohort study, earlier ECMO treatment was associated with lower in-hospital mortality among unstable patients without cardiac arrest. Our findings suggest that ECMO can be considered as an initial treatment option for patients with high-risk PE in higher-volume hospitals.

研究目的
静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation, VA-ECMO）正日益被用于治疗高危肺栓塞（pulmonary embolism, PE），但其疗效与安全性仍不明确。本回顾性队列研究旨在探讨ECMO是否可改善高危PE患者的临床结局。

研究方法
本研究纳入2012年1月至2019年12月期间于高雄长庚纪念医院收治的40例高危PE患者。将患者分为未接受ECMO治疗的非ECMO组与接受ECMO治疗的ECMO组，比较两组的人口统计学资料与临床结局。采用合适的统计学工具比较组间变量，并通过Kaplan-Meier法（Kaplan–Meier method）分析患者生存情况。

研究结果
本研究总体住院死亡率为55%，其中65%（26/40）的患者发生心搏骤停，该亚组的死亡率达77%，显著高于未发生心搏骤停的患者（14%）。非ECMO组与ECMO组的严重并发症发生率及住院死亡率均无显著差异。但亚组分析显示，与未接受ECMO治疗的患者相比，早期ECMO治疗可降低心搏骤停风险（P=0.023），并降低住院死亡率（P=0.036）。对数秩检验（log-rank test）显示，早期ECMO治疗组的累积总生存率显著更高（P=0.033）。

研究结论
本回顾性队列研究结果表明，对于未发生心搏骤停的不稳定高危PE患者，早期ECMO治疗与更低的住院死亡率相关。本研究结果提示，在高容量医疗中心，ECMO可作为高危PE患者的初始治疗选择。