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Objective The role of exercise therapy after acute pulmonary embolism (PE) is unknown. Exercise therapy is safely used after myocardial infarction and chronic obstructive pulmonary disease. The aim of this study was to investigate the safety of exercise therapy after acute PE. Methods We implemented a 3-month exercise program after acute PE. Outcomes were death, bleeding, readmissions, recurrent events, changes in peak VO2 and quality of life (QoL). Results A total of 23 patients were enrolled and received anticoagulation; no adverse events were reported during the exercise period. One death, 1 DVT and 5 readmissions were reported due to non-exercise related reasons. Functional capacity improved as evidenced by an increased peak VO2 at 3 months (+3.9 ± 5.6 mL/kg/min; p = 0.05). Improvement in QoL was observed at 6-months on the functional (+17.0 ± 22.6, p = 0.03) and physical health factor scales (+0.9 ± 4.6, p = 0.03). Conclusion Exercise therapy is feasible and safe in appropriately anticoagulated patients after PE.

Background Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound‐assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA‐ECMO for PE. Methods A review of all VA‐ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in‐hospital death, 90‐day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO. Results Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA‐ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in‐hospital death, and were alive at 90‐day follow‐up. Conclusion Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA‐ECMO for PE, and allow for survival with RV recovery with minimal complications.

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