Massive Pulmonary Embolism Requiring Extracorporeal Life Support Treated With Catheter-Based Interventions

Abstract

SummaryWhen pulmonary embolism (PE) develops, circulatory collapse and hypoxia are caused at the same time. The rapid and proper use of extracorporeal life support (ECLS) can improve the mortality rate of patients with collapsed massive PE. No study has examined the influence of treatment that involved adding catheter based-intervention to ECLS with massive collapsed PE. Thirty-five patients with massive PE were examined, and 10 of these patients were placed on ECLS. Eight of the 10 patients placed on ECLS for massive PE were female, and the median age was 61 years. Seven patients had in-hospital onset PE and 3 patients out-of-hospital onset PE. Their underlying conditions were a cerebral infarction (3 patients), coronary artery disease (5 patients), collagen disease (one patient), postoperative state (3 patients), and lung disease (2 patients). Pulmonary angiographic findings showed that a filling defect or complete occlusion was observed in all 10 patients in the proximal lobular arteries, 6 of which had large thrombi stretching to the main pulmonary arteries. All patients underwent thrombolysis. Percutaneous catheter embolus fragmentation and/or thrombectomy were undertaken in 7 patients. All patients required red blood cell transfusion for cannulation site bleeding. The mean duration of ECLS bypass was 48 ± 44 hours. The 30 day mortality rate was 30%. The current study clarified the characteristics of patients with massive PE requiring ECLS. These patients have extensive pulmonary thromboemboli, thus, the aggressive use of catheter-based intervention appears to have beneficial effects for massive PE requiring ECLS. (Int Heart J 2012; 53: 370-374)

Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

“…Veno-arterial extracorporeal membrane oxygenation could be used to rescue patients when thrombolytic treatment fails or as temporary hemodynamic support prior to surgical 21 or catheter-based embolectomy. 22 Our study has limitations. First, it is a retrospective, single-center study.…”

Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation

“…However, those recommendations might be questionable for the sickest patients in severe shock or cardiac arrest, when thrombolysis takes time to be effective and surgery is not immediately available. Therefore, VA-ECMO could be used to rescue patients when thrombolytic treatments fail or as temporary hemodynamic support prior to surgical [29] or catheter-based embolectomy [30]. However, surgical embolectomy is a major intervention requiring sternotomy and cardiopulmonary bypass that carries significant morbidity and mortality in this context of advanced shock and multiorgan failure; hence, VA-ECMO might also be used alone until heparin-induced and spontaneous endogenous thrombolysis permit weaning-off support [5].…”

Extracorporeal life support for adult cardiopulmonary failure

“…[59][60][61] Extracorporeal cardiopulmonary resuscitation. With over 200,000 in-hospital cardiac arrests in the United States each year and a survival to discharge rate of only 18-20%, many are exploring alternative strategies to conventional resuscitation.…”