PB0505 - Outcomes of patients with pulmonary embolism admitted to the Intensive Care Unit

Background: Pulmonary embolism (PE) that requires admission to the intensive care unit (ICU) is associated with high mortality. Systemic thrombolysis (ST) and extracorporeal life support (ECLS) may improve outcomes but are associated with significant risks.

Aims: To assess 1) outcomes of patients with PE admitted to our ICU; 2) the impact of ST and ECLS on outcome; and 3) clinical features associated with outcome.

Methods: Retrospective cohort study of adult patients admitted to our institution’s ICU July 2013 – December 2020 with an ICD-coded PE diagnosis. Ethics approval was granted.

Results: We identified 1998 individuals with PE. 113 (5.7%) required ICU admission. Baseline characteristics are shown in Table 1. 25 patients (22.1%) required ECMO and 37 (32.7%) received ST. 33 (29.2%) patients had bleeding; 17 (15.0%) were major bleeds. 48 (42.5%) patients died in the study period of all causes; 37 (32.7% of the entire cohort) died within 30 days. Those who died within 30 days of diagnosis had a higher frailty score (4 vs 3, p=0.03), higher APACHE III score (90.5 vs 49, p< 0.001), higher troponin (685 vs 123, p< 0.001), higher D-dimer (174 vs 16, p=0.03) and were more likely to require ECMO (40.5% vs 13.2%, p< 0.001) than those who survived. There was no difference in mortality in those who received ST than those that did not (48.5% vs 39.5%, p=0.419) but was associated with a higher rate of major bleeding (29.7% vs 7.9%, p=0.004).

Conclusion(s): Patients with PE requiring ICU admission have a high mortality rate. Frailty, high APACHE III score, high troponin and D-dimer and the need for ECMO correlate with mortality. Unlike published studies, ST did not improve mortality, potentially because our cohort was very high-risk, and was associated with more bleeding. These results indicate novel approaches may be required to improve outcomes in this high-risk group.