Massive Embolism: Knife versus PCI

Abstract

Pulmonary embolism is the third most common cardiovascular syndrome with an estimated up to 25% of patients presenting with sudden death. For those who survive, a mainstay of management for patients with hemodynamic stability is anticoagulation; however, recommendations and options are rapidly changing for patients with submassive or massive pulmonary embolism with hemodynamic instability. Catheter-based and surgical approaches offer efficacious management options for unstable patients or patients with contraindications to anticoagulation; however, both approaches have inherent benefits and risk. This article seeks to offer a brief review on the recommendations and options for management of pulmonary embolism from both surgical and catheter-based perspectives.

Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism

“…24 As noted by Tohme et al, PE patients with a history of malignancy have a considerably higher mortality than those without a history of malignancy, and thus patients with widespread malignancy may not be considered for ECMO. 5 As previously noted in the study by George et al, serum lactate level >6 mmol/L at presentation may suggest futility of the use of ECMO. 20 V-A ECMO is associated with high rates of major complications including infection, bleeding, stroke, and limb ischemia, providing daily challenges to the ECMO team.…”

“…1 In searching for strategies that may make a dent on this dismal mortality rate, investigators have, in the last decade, shown renewed interest in the potential beneficial role of venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) in the treatment of patients with high-risk PE and, in particular, those with circulatory collapse or cardiac arrest. [2][3][4][5][6][7][8][9][10][11] In this review, we outline the mechanism, design, and operation of the V-A ECMO system; provide a brief overview of the historical background of this treatment modality; and discuss current and future applications.…”

“…1 In searching for strategies that may make a dent on this dismal mortality rate, investigators have, in the last decade, shown renewed interest in the potential beneficial role of venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) in the treatment of patients with high-risk PE and, in particular, those with circulatory collapse or cardiac arrest. 2 3 4 5 6 7 8 9 10 11…”