365: Use of Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolus in a Peripartum Patient

Nemani, Lakshmi A.; Al-Qamari, Abbas; Budd, Ashley N.

doi:10.1097/01.ccm.0000727348.19209.c5

Cited by 1 publication

(3 citation statements)

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“…6 Two cases utilized rheolytic thrombectomy where high-pressured jet streams disrupt the thrombus that is aspirated into the catheter. 12,18,19 Our review of literature also yielded two similar cases of catheter-directed embolectomy by entrapment in a peripartum patient: one published by Yarusi et al and one presented by Nemani et al at a meeting. 19 However, the patient in both cases had to be placed emergently on venoarterial extracorporeal membrane oxygenation (VA-ECMO) due to cardiac arrest, which we were able to avoid with our patient.…”

Section: Discussionmentioning

confidence: 64%

“…Our review of literature also yielded two similar cases of catheter-directed embolectomy by entrapment in a peripartum patient: one published by Yarusi et al and one presented by Nemani et al at a meeting. 19 However, the patient in both cases had to be placed emergently on venoarterial extracorporeal membrane oxygenation (VA-ECMO) due to cardiac arrest, which we were able to avoid with our patient. 14 This discrepancy could be due to our patient presenting during the first trimester of her pregnancy and her initial hemodynamic instability leading to a rapid decision to treat with catheter-directed embolectomy.…”

Section: Discussionmentioning

confidence: 93%

“…6 Two cases utilized rheolytic thrombectomy where high-pressured jet streams disrupt the thrombus that is aspirated into the catheter. 12 18 19…”

Section: Discussionmentioning

confidence: 99%

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Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy

Truong,

Cheyney,

et al. 2024

AJP Rep

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Pulmonary embolism (PE) is associated with approximately 10.5% of maternal deaths in the United States. Despite heightened awareness of its mortality potential, there is little data available to guide its management in pregnancy. We present the case of a massive PE during gestation successfully treated with catheter-directed embolectomy. A 37-year-old G2P1001 presented with a syncopal episode preceded by dyspnea and chest pain. Upon presentation, she was hypotensive, tachycardiac, and hypoxic. Imaging showed an occlusive bilateral PE, right heart strain, and a possible intrauterine pregnancy. Beta-hCG was positive. She was taken emergently for catheter-directed embolectomy. Her condition immediately improved afterwards. Post-procedure pelvic ultrasound confirmed a viable intrauterine pregnancy at 10 weeks gestation. She was discharged with therapeutic enoxaparin and gave birth to a healthy infant at 38 weeks gestation. Despite being the gold standard for PE treatment in non-pregnant adults, systemic thrombolysis is relatively contraindicated in pregnancy due to concern for maternal or fetal hemorrhage. Surgical or catheter-based thrombectomies are rarely recommended. Limited alternative options forces their consideration, particularly in a hemodynamically unstable patient. Catheter-directed embolectomy can possibly bypass such complications. Our case exemplifies the consideration of catheter-directed embolectomy as the initial treatment modality of a hemodynamically unstable gestational PE.

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