Neurological recovery from multiple cardiac arrests due to acute massive pulmonary embolism managed by cardiopulmonary resuscitation and extracorporeal membrane oxygenation

Algahtani, Hussein; Mohammed, Azzam; Albanna, Amr S.; Shirah, Bader

doi:10.1016/j.carrev.2017.07.010

Cited by 3 publications

(2 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…About 77 studies were included in this review (Fig. 1) and were assessed for bias using Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses (19–95). Our review considered articles to have a low risk of bias if all checklist criteria were met, moderate risk if greater than or equal to 75% of criteria were met, and high risk if less than 75% of criteria were met.…”

Section: Methodsmentioning

confidence: 99%

Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

Scott

Gordon

Vender

et al. 2021

Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVE: Management of patients experiencing massive pulmonary embolism-related cardiac arrest is controversial. Venoarterial extracorporeal membranous oxygenation has emerged as a potential therapeutic option for these patients. We performed a systematic review assessing survival and predictors of mortality in patients with massive PE-related cardiac arrest with venoarterial extracorporeal membranous oxygenation use. DATA SOURCES: A literature search was started on February 16, 2020, and completed on March 16, 2020, using PubMed, Embase, Cochrane Central, Cinahl, and Web of Science. STUDY SELECTION: We included all available literature that reported survival to discharge in patients managed with venoarterial extracorporeal membranous oxygenation for massive PE-related cardiac arrest. DATA EXTRACTION: We extracted patient characteristics, treatment details, and outcomes. DATA SYNTHESIS: About 301 patients were included in our systemic review from 77 selected articles (total screened, n = 1,115). About 183 out of 301 patients (61%) survived to discharge. Patients (n = 51) who received systemic thrombolysis prior to cannulation had similar survival compared with patients who did not (67% vs 61%, respectively; p = 0.48). There was no significant difference in risk of death if PE was the primary reason for admission or not (odds ratio, 1.62; p = 0.35) and if extracorporeal membranous oxygenation cannulation occurred in the emergency department versus other hospital locations (odds ratio, 2.52; p = 0.16). About 53 of 60 patients (88%) were neurologically intact at discharge or follow-up. Multivariate analysis demonstrated three-fold increase in the risk of death for patients greater than 65 years old (adjusted odds ratio, 3.08; p = 0.03) and six-fold increase if cannulation occurred during cardiopulmonary resuscitation (adjusted odds ratio, 5.67; p = 0.03). CONCLUSIONS: Venoarterial extracorporeal membranous oxygenation has an emerging role in the management of massive PE-related cardiac arrest with 61% survival. Systemic thrombolysis preceding venoarterial extracorporeal membranous oxygenation did not confer a statistically significant increase in risk of death, yet age greater than 65 and cannulation during cardiopulmonary resuscitation were associated with a three- and six-fold risks of death, respectively.

show abstract

Section: Methodsmentioning

confidence: 99%

Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

Scott

Gordon

Vender

et al. 2021

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Pulmonary embolism (PE)-associated cardiac arrest is associated with a high mortality rate, and treatment options include systemic thrombolysis, mechanical embolectomy, and extracorporeal membrane oxygenation (ECMO) when available, usually in addition to systemic anticoagulation. There is a paucity of literature addressing patient outcomes after the administration of a systemic thrombolytic during cardiac arrest secondary to confirmed massive PE with subsequent need for ECMO, with even fewer data in undifferentiated cardiac arrest [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Furthermore, there is a high likelihood of publication bias, with positive outcomes more likely to be reported.…”

Section: Introductionmentioning

confidence: 99%

Negative Outcome Following Systemic Alteplase Administration Prior to Extracorporeal Membrane Oxygenation in a Kidney Transplant Patient With Cardiac Arrest: A Case Report

2022

View full text Add to dashboard Cite

A case of a negative outcome following systemic alteplase administration prior to extracorporeal membrane oxygenation (ECMO) in a kidney transplant patient with cardiac arrest is reported. A patient status-post kidney transplantation was admitted to the surgical intensive care unit (ICU) and experienced cardiac arrest after developing sudden-onset chest pain and shortness of breath. During cardiopulmonary resuscitation, alteplase 50 mg was administered intravenous push for suspected pulmonary embolism (PE) before the patient was evaluated for and started on veno-arterial ECMO. Within several hours, cardiopulmonary resuscitation needed to be reinitiated. Ultimately, the decision was made to cede further resuscitation efforts due to futility. A post-mortem examination included an immediate cause of death of acute myocardial infarction with extensive retroperitoneal hemorrhage. The role of ECMO is emerging in cardiac arrest, and should be considered as a management option before the administration of systemic thrombolysis in patients with increased bleeding risk.

show abstract

Survival Without Neurological Sequelae Following Massive Pulmonary Embolism and Prolonged Cardiac Arrest

Paciorkowski,

Nahban,

Jacques

2024

Cureus

View full text Add to dashboard Cite

We present the case of a 17-year-old female who survived cardiac arrest caused by a massive pulmonary embolism leading to obstructive shock. Despite a prolonged low-flow period of 193 minutes, she fully recovered without apparent neurological damage, thanks to immediate cardiopulmonary resuscitation (CPR) initiated by her father, timely intervention by paramedics and medical teams, and the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Key factors in her recovery included the absence of a no-flow period, maintenance of end-tidal CO 2 (ETCO 2 ) levels above 25-30 mmHg during resuscitation, and the vital role of VA-ECMO in supporting organ perfusion. This case highlights the importance of prompt bystander intervention, continuous ETCO 2 monitoring during CPR, and the integration of advanced circulatory support measures in post-cardiac arrest care. Additionally, it underscores the potential for favorable neurological outcomes even after extended resuscitation, provided there is adequate cerebral perfusion and timely mechanical support. The report emphasizes the need for public education on basic life support (BLS).

show abstract

Neurological recovery from multiple cardiac arrests due to acute massive pulmonary embolism managed by cardiopulmonary resuscitation and extracorporeal membrane oxygenation

Cited by 3 publications

References 10 publications

Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*

Negative Outcome Following Systemic Alteplase Administration Prior to Extracorporeal Membrane Oxygenation in a Kidney Transplant Patient With Cardiac Arrest: A Case Report

Survival Without Neurological Sequelae Following Massive Pulmonary Embolism and Prolonged Cardiac Arrest

Contact Info

Product

Resources

About