Northern Westchester Hospital 400 E Main Street, Mount Kisco NY 10549 New York, NY
Introduction: Patients with hemodynamic instability from high-risk pulmonary embolism (PE) require emergent care that often demands significant, intensive resources. Growing evidence suggests mechanical thrombectomy (MT) is an effective and safe reperfusion therapy for PE, but its impact on critical care utilization is less clear. Here, postprocedure intensive resource use was evaluated in a combined assessment of patients with high-risk PE from 2 studies of a MT intervention.
Methods: This pooled analysis includes patients from the prospective, observational, and multicenter FLAME (NCT04795167) and FLASH (NCT03761173) studies. FLAME enrolled consecutive patients with high-risk PE treated using the FlowTriever System (Inari Medical, Irvine, CA) or other therapies. The FLASH registry included patients with intermediate- or high-risk PE treated with FlowTriever. In both studies, diagnosis of high-risk PE was made at the site level based on ESC guidelines.
Results: A total of 116 patients with high-risk PE treated using MT were included in the analysis, 53 from FLAME and 63 from FLASH. The mean age was 61.8±15.6 years, and 60 (51.7%) patients were women. All patients were hemodynamically unstable at presentation. In addition, 22 (19.0%) patients required life support via CPR, extracorporeal membrane oxygenation (ECMO), or intubation, while 46 (39.7%) needed vasopressors alone. Post MT, 1 (0.9%) in-hospital all-cause mortality occurred. Two (1.7%) patients required ECMO, 5 (4.6%) were intubated, 24 (22.0%) needed supplemental oxygen via nasal cannula or face mask, and 8 (6.9%) required new administration of vasopressors. Six (5.2%) major bleeds occurred, 4 (3.4%) of which necessitated transfusions; there were no intracranial hemorrhages. The median number of postprocedure overnights in the ICU was 1.0 [IQR 0.0–2.0], with 35 (31.3%) patients having no overnight ICU stay.
Conclusions: Across 2 prospective studies encompassing 116 patients with high-risk PE who were treated using MT, there was a low in-hospital mortality rate of 0.9% despite severe disease on presentation. In addition, postprocedure critical care resource utilization was minimized, including infrequent use of the ICU, ECMO, intubation, transfusion, and new vasopressors.
