Management of high-risk acute pulmonary embolism: an emulated target trial analysis
Authors' conclusion
Advanced 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.
Study context
- Population
- Patients treated for high-risk acute pulmonary embolism (PE)of 1060 assessed
- Participants
- 991 patients
- Exposure
- SYS, surgical thrombectomy (ST) or percutaneous catheter-directed treatment (PCDT) vs veno-arterial extracorporeal membrane oxygenation (VA-ECMO) alone
- VA-ECMO alonen = 126reference
- SYSn = 643
- STn = 49
- PCDTn = 173
- Outcome
- All-cause in-hospital mortality
Methodological detailsg-formula with logistic regression, sensitivity analyses (targeted maximum likelihood estimation (TMLE), inverse probability of treatment weighting (IPTW))
- G-formula with logistic regression
- Sensitivity analyses (TMLE, IPTW)
Main finding
As reported in the abstract
Estimated probability of in-hospital mortality
Observational data: associations, not effects.
Further findings
Favorable neurologic outcome in survivors to discharge (crude analysis)
- High probability of favorable neurologic outcome in all treatment groups
Original publication
Management of high-risk acute pulmonary embolism: an emulated target trial analysis. Intensive Care Med. Published 25 February 2025. doi:10.
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