Extracorporeal Life Support for Massive Pulmonary Embolism

Maggio, Paul M.; Hemmila, Mark R.; Haft, Jonathan W.; Bartlett, Robert H.

doi:10.1097/ta.0b013e318031cd0c

Cited by 166 publications

(155 citation statements)

References 27 publications

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“…14,15) The use of ECLS is effective for collapsed massive PE, and the in-hospital mortality rate has been reported to range from 38-43%. 6,14) The 30 day mortality rate in the present study was 30%, which was equal to or better than the outcome described in previous reports.…”

Section: Discussioncontrasting

confidence: 41%

“…Another advantage is the ability to quickly wean the patient from ECLS. Maggio 6) reported 21 patients treated by ECLS for massive PE. Eight patients were treated with only ECLS, while the others received additional treatment (thrombolysis; catheter embolectomy; thrombolysis + catheter embolectomy; surgical embolectomy; in 2, 4, 3, and 4 patients, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Extracorporeal life support (ECLS) 5) is the most convenient circulatory assist method widely available and is the alternative of choice for treating patients with PE with circulatory collapse. 6) Catheter-based intervention is recommended for patients with circulatory collapse due to a massive PE, and it is equivalent to a surgical embolectomy. 7) The clinical characteristics and outcomes of patients with massive PE treated by ECLS with catheter-based intervention have not yet been fully clarified and therefore were examined in the present study.…”

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confidence: 99%

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

et al. 2012

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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)

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2012

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“…The largest patient group was described by Maggio et al 26 The authors studied 21 patients who received extracorporeal support for circulatory failure due to massive pulmonary embolism from January 1992 to December 2005. Thirteen patients survived (62%).…”

Section: Discussionmentioning

confidence: 99%

“…25 In Maggio's study, 4 of 21 patients died during ECLS therapy. 26 Another 27-year-old female patient, who developed postpartum pulmonary embolism with persistent circulatory failure, was bleeding with hemorrhagic shock after thrombolytic therapy. After implantation of a portable hand-held ECLS, her circulation and oxygenation could be maintained.…”

Section: Complications and Course Of Eclsmentioning

confidence: 99%

Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients – a case series

et al. 2015

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Background: Extracorporeal life support (ECLS) devices maintain the circulation and oxygenation of organs during acute right ventricular failure and cardiogenic shock, bypassing the lungs. A pulmonary embolism can cause this life-threatening condition. ECLS is a considerably less invasive treatment than surgical embolectomy. Whether to bridge embolectomy or for a therapeutic purpose, ECLS is used almost exclusively following failure of all other therapeutic options. Methods: From January 1, 2008 to June 30, 2014, five patients in cardiac arrest and with diagnosed pulmonary embolism (PE) were cannulated with the ECLS system. Results: PE was diagnosed using computer tomography scanning or echocardiography. Cardiac arrest was witnessed in the hospital in all cases and CPR (cardiopulmonary resuscitation) was initiated immediately. Cannulation of the femoral vein and femoral artery was always performed under CPR conditions. Right heart failure regressed during the ECLS therapy, usually under a blood flow of 4-5 L/min after 48 hours. Three patients were weaned from ECLS and one patient became an organ donor. Finally, two of the five PE patients treated with ECLS were discharged from inpatient treatment without neurological dysfunction. The duration of ECLS therapy depends on the patient's condition. Irreversible damage to the organs after hypoxemia limits ECLS treatment and leads to futile multiorgan failure. Hemorrhages after thrombolysis and cerebral dysfunction were further complications. Conclusions: Veno-arterial cannulation for ECLS can be feasibly achieved and should be established during active CPR for cardiac arrest. In the case of PE, the immediate diagnosis and rapid implantation of the system are decisive for therapeutic success.

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Treatment with new organic nitrites in pulmonary hypertension of acute experimental pulmonary embolism

Nilsson

Gustafsson

2019

Pharmacology Res & Perspec

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Acute pulmonary embolism may cause right heart failure due to increased pulmonary vascular resistance and arterial hypoxemia. Effective vasodilator therapy of the pulmonary hypertension is highly needed. Therefore, we investigated the effects of a newly developed effective pulmonary vasodilator, the organic mononitrites of 1,2‐propanediol (PDNO), in a rabbit model of acute pulmonary embolism. In anesthetized and ventilated rabbits, systemic and pulmonary hemodynamics, exhaled nitric oxide (NO), plasma nitrite concentration, and blood gases were monitored. First, dose–response experiments with intravenous and left heart ventricle infusions of PDNO and inorganic nitrite were done in naive animals and in pulmonary hypertension induced by a thromboxane A2 analogue. Second, acute pulmonary embolism was induced and either PDNO or placebo were administered intravenously within 20 minutes and evaluated within 1 hour after pulmonary embolization. PDNO intravenously, in contrast to inorganic nitrite intravenously, increased exhaled NO and counteracted pulmonary hypertension and vasodilated the systemic circulation, dose‐dependently, thereby showing efficient NO donation. Pulmonary embolization induced pulmonary hypertension and gas exchange disturbances. PDNO significantly decreased and normalized pulmonary vascular resistance and the right ventricle rate‐pressure product, without causing tolerance, with no significant side effects on the systemic circulation, nor on blood‐gas values or on methemoglobin formation. In conclusion, PDNO is a NO donor and an efficient vasodilator in the pulmonary circulation. Treatment with this or similar organic nitrites intravenously may be a future option to avoid right heart failure in life‐threatening acute pulmonary embolism.

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Extracorporeal Life Support for Massive Pulmonary Embolism

Abstract: We conclude that emergent ECLS provides an opportunity to improve the prognosis of an otherwise near-fatal condition, and should be considered in the algorithm for management of a massive pulmonary embolism in an unstable patient.

Cited by 166 publications

References 27 publications

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

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

Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients – a case series

Treatment with new organic nitrites in pulmonary hypertension of acute experimental pulmonary embolism

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