Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Jeong, Won Joon; Lee, Jun Wan; Yoo, Youn Ho; Ryu, Seung Ho; Cho, Sung Wook; Song, Kyoung Hyuk; Park, Sang-Il

doi:10.1016/j.ajem.2015.07.026

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Non-neonatal pediatric ECMO cases with a variety of indications have increased [12]. In the past tumor-related reports, ECPR was performed for a patient with metastatic choriocarcinoma, a patient with lymphoma, and another patient with leukemia who developed PE [13–15]. The case with choriocarcinoma presented with severe dyspnea, massive hemoptysis, and decreased mean BP in the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Although the third case was not successfully resuscitated even with ECMO support and emergency surgery in the hospital [14], both cases were started on ECMO before cardiac arrest. A patient with lymphoma who had a cardiac arrest for 8 min and achieved successful recovery of spontaneous circulation received bridging ECMO support, leading to discharge without any other serious complications [15]. We suggest that ECMO at tertiary hospitals should be considered for potentially fatal cases of massive pulmonary tumor embolism of Wilms tumor before or immediately after cardiac arrest (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

et al. 2019

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BackgroundFinding an abdominal mass or hematuria is the initial step in diagnosing Wilms tumor. As the first manifestation of Wilms tumor, it is exceedingly rare for pulmonary tumor embolism to present with cardiac arrest. A case of a patient whose sudden cardiac arrest due to massive pulmonary tumor embolism of Wilms tumor was not responsive to resuscitation is presented.Case presentationThe patient was a five-year-old girl who collapsed suddenly during activity in nursery school and went into cardiac arrest in the ambulance. Unfortunately, she was not responsive to conventional resuscitation. A judicial autopsy conducted at the local police department showed the main cause of her sudden cardiac arrest was attributed to multiple pulmonary tumor embolisms of stage IV Wilms tumor.ConclusionsExcept for one reported case, treatments were not successful in all eight cardiac arrest cases with pulmonary tumor embolism of Wilms tumor. These results indicate that it is challenging not only to make an accurate diagnosis, but also to provide proper specific treatment in the cardiac arrest setting. We propose that flexible triage and prompt transfer to a tertiary hospital are necessary as an oncologic emergency to get such patients to bridging therapy combined with extracorporeal membrane oxygenation or immediate surgical intervention under cardiopulmonary bypass.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

et al. 2019

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“…Supporting our findings, several case reports and small case series have suggested that ECMO may have a role in decreasing mortality in patients with massive PE. [4][5][6][7][8][9][10][11][12] One case series spanning 13 years included 21 patients with massive PE, 13 of whom developed cardiogenic shock and eight that had ongoing cardiac arrest. Thirteen of the 21 patients (62%) survived to 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…3 As hemodynamic improvement is not often immediate after treatment for highrisk PE, extra-corporeal membrane oxygenation (ECMO) has been suggested for cardiopulmonary support either as a bridge to therapy or as support after therapy. [4][5][6][7][8][9][10][11][12] Through bypass of the failing right ventricle and lungs, ECMO maintains cardiac output and mitigates end-organ damage while definitive PE treatment is undertaken. Utilization of ECMO may allow for aggressive treatment of high-risk PE -including administration of thrombolytic medications, catheterdirected interventions, and surgical embolectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Emerging but limited data suggest that aggressive management of high-risk PE, including the institution of ECMO, may improve morbidity and mortality in massive PE. [4][5][6][7][8][9][10][11][12] Thus, ECMO has been employed in our institution with the aim of improving hemodynamic parameters and clinical outcomes in patients with highrisk PE.…”

Section: Introductionmentioning

confidence: 99%

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Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

et al. 2017

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Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era ( n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era ( p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.

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

Scott

Gordon

Vender

et al. 2021

Critical Care Medicine

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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.

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Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Cited by 8 publications

References 11 publications

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

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

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