End-point Analysis, complications and 90-Day Survival
The preoperative mean embolic burden score was 19.5 ± 4.7 and decrease to 1.4 ± 2.1 for survivor patients (Table 3). Follow-up contrast-enhanced CT studies were performed after 76 ± 12 hours. The patients saddle pulmonary embolisms were clearly disappeared after successful treatment in the CT follow-up ( Figure 3B). For survivor patients, the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 at follow-up (p<0.001) and the mean right ventricular end diastolic diameter was reduced from 54.3 ± 6.6 to 41.5 ± 5.3 mm.
Table 3 reports ECMO-related complications and short-term outcomes according to 90-day status. Seven of 29 patients (20.6%) experienced at least one minor ECMO-related complication; 7 (24.1%) patients had a moderate hemorrhage classified as GUSTO ≤2 with a mean of 2.2 ± 0.3 (1-4) packed red-cell and 3.1 ± 0.8 (1–5) fresh-frozen plasma units transfused. Four of 29 patients (13.7%) experienced acute kidney injury that required renal replacement therapy during the hospitalization. However, only 2 of those patients required dialysis after discharge, which was discontinued during follow-up.
Other complications included: ischemic stroke in three patients, with two recovering to normal neurological function at hospital discharge and 1 patient develop hypoxic-ischemic encephalopathy, and two surgical cannulas related, wound-infection debridement. In our patient series, the patients did not demonstrate any signs of acute limb ischemia, the distal perfusion cannula prevented acute limb ischemia.
Twenty-two patients survived to hospital discharge, with a mean ICU stay of 8.9 ± 1.6 days (range 7 to 22) and mean length of hospital stay of 23.7 ± 8.5 days (range, 11 to 44 days). Six patients died from refractory shock despite ECMO support and cardiac arrest-related multiorgan failure. One patient died after successful ECMO weaning with PE recurrence 55 days post- ECMO removal despite adequate anticoagulation. Ninety-day mortality was 24.1% (7/29) and one-year mortality was 27.5% (8/29). Compared with patients who died within 90 days, it is worth noting that 90-day survivors had
significantly lower inotrope scores 24 hours post ECMO cannulation and lower SAPS II and SOFA scores on ECMO day 1 (Table 3).