Stadlbauer, Andrea and Verbelen, Tom and Binzenhoefer, Leonhard and Goslar, Tomaz and Supady, Alexander and Spieth, Peter M. and Noc, Marko and Verstraete, Andreas and Hoffmann, Sabine and Schomaker, Michael and Hoepler, Julia and Kraft, Marie and Tautz, Esther and Hoyer, Daniel and Tongers, Joern and Haertel, Franz and El-Essawi, Aschraf and Salem, Mostafa and Rangel, Rafael Henrique and Hullermann, Carsten and Kriz, Marvin and Schrage, Benedikt and Moises, Jorge and Sabate, Manel and Pappalardo, Federico and Crusius, Lisa and Mangner, Norman and Adler, Christoph and Tichelbaecker, Tobias and Skurk, Carsten and Jung, Christian and Kufner, Sebastian and Graf, Tobias and Scherer, Clemens and Villegas Sierra, Laura and Billig, Hannah and Majunke, Nicolas and Speidl, Walter S. and Zilberszac, Robert and Chiscano-Camon, Luis and Uribarri, Aitor and Riera, Jordi and Roncon-Albuquerque Jr, Roberto and Terauda, Elizabete and Erglis, Andrejs and Tavazzi, Guido and Zeymer, Uwe and Knorr, Maike and Kilo, Juliane and Moebius-Winkler, Sven and Schwinger, Robert H. G. and Frank, Derk and Borst, Oliver and Haeberle, Helene and De Roeck, Frederic and Vrints, Christiaan and Schmid, Christof and Nickenig, Georg and Hagl, Christian and Massberg, Steffen and Schaefer, Andreas and Westermann, Dirk and Zimmer, Sebastian and Combes, Alain and Camboni, Daniele and Thiele, Holger and Luesebrink, Enzo and High-risk PE Investigator Grp, Tom (2025) Management of high-risk acute pulmonary embolism: an emulated target trial analysis. INTENSIVE CARE MEDICINE, 51 (3). pp. 490-505. ISSN 0342-4642, 1432-1238
Full text not available from this repository. (Request a copy)Abstract
BackgroundHigh-risk acute pulmonary embolism (PE) is a life-threatening condition necessitating hemodynamic stabilization and rapid restoration of pulmonary perfusion. In this context, evidence regarding the benefit of advanced circulatory support and pulmonary recanalization strategies is still limited.MethodsIn this observational study, we assessed data of 1060 patients treated for high-risk acute PE with 991 being included in a target trial emulation to investigate all-cause in-hospital mortality estimates with different advanced treatment strategies. The four treatment groups consisted of patients undergoing (I) veno-arterial extracorporeal membrane oxygenation (VA-ECMO) alone (n = 126), (II) intrahospital systemic thrombolysis (SYS) (n = 643), (III) surgical thrombectomy (ST) (n = 49), and (IV) percutaneous catheter-directed treatment (PCDT) (n = 173). VA-ECMO was allowed as bridging to pulmonary recanalization in groups II, III, and IV. Marginal causal contrasts were estimated using the g-formula with logistic regression models as the primary approach. Sensitivity analyses included targeted maximum likelihood estimation (TMLE) with machine learning, inverse probability of treatment weighting (IPTW), as well as variations of estimands, handling of missing values, and a complete target trial emulation excluding the VA-ECMO alone group.ResultsIn the overall target trial population, the median age was 62.0 years, and 53.3% of patients were male. The estimated probability of in-hospital mortality from the primary target trial intention-to-treat analysis for VA-ECMO alone was 57% (95% confidence interval [CI] 47%; 67%), compared to 48% (95% CI 44%; 53%) for intrahospital SYS, 34% (95%CI 18%; 50%) for ST, and 43% (95% CI 35%; 51%) for PCDT. The mortality risk ratios were largely in favor of any advanced recanalization strategy over VA-ECMO alone. The robustness of these findings was supported by all sensitivity analyses. In the crude outcome analysis, patients surviving to discharge had a high probability of favorable neurologic outcome in all treatment groups.ConclusionAdvanced recanalization by means of SYS, ST, and several promising catheter-directed systems may have a positive impact on short-term survival of patients presenting with high-risk PE compared to the use of VA-ECMO alone as a bridge to recovery.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MULTICENTER TRIAL; SINGLE-ARM; THROMBOLYSIS; FIBRINOLYSIS; OUTCOMES; High-risk pulmonary embolism; Systemic thrombolysis; Surgical thrombectomy; Percutaneous catheter-directed treatment; Mechanical circulatory support |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 31 Mar 2026 09:24 |
| Last Modified: | 31 Mar 2026 09:24 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67849 |
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