Postcesarean Pulmonary Embolism, Sustained Cardiopulmonary Resuscitation, Embolectomy, and Near-Death Experience

Marty, Alan T.; Hilton, Frank L.; Spear, Robert K.; Greyson, Bruce

doi:10.1097/01.aog.0000164054.53501.96

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…The patients with APE and treated by PCPS were diagnosed using pulmonary angiography and CT 21) in a similar way in milder APE, although trans-thoracic or trans-esophageal echocardiography which detected thrombus echo in the right atrium, the right ventricle or the proximal pulmonary artery were occasionally applied in certain circumstances. 22) PCPS was often used to obtain hemodynamic stability before the definitive diagnosis was established.…”

Section: Diagnosis Of Ape Treated With Pcpsmentioning

confidence: 99%

Percutaneous Cardiopulmonary Support for the Treatment of Acute Pulmonary Embolism: Summarized Review of the Literature in Japan Including Our Own Experience

Sakuma

Nakamura

Yamada

et al. 2009

Annals of Vascular Diseases

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M ortality in acute pulmonary embolism (APE) is high with a quarter of APE with circulatory collapse dying within one hour, 1) and with half of those with cardiopulmonary arrest (CPA) dying within 30 days (most of the deaths occurred on the day of diagnosis or 1 day after diagnosis was made).2) Intra-venous administration of thrombolytic therapy was introduced for the patients with CPA who did not respond to usual cardiopulmonary resuscitation. 3, 4) Percutaneous cardiopulmonary support (PCPS; = extracorporeal membrane oxygenation) may be another alternative of choice to treat fulminant APE. 5, 6) However there have been no reports with a large number of series of APE treated with the use of PCPS.Our aims are to examine the effectiveness of the treatment by PCPS for the patients of APE and to compare the efficacies of PCPS among those patients treated concurrently with surgical embolectomy, catheter therapy (aspiration and/or fragmentation), and thrombolysis.

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Section: Diagnosis Of Ape Treated With Pcpsmentioning

confidence: 99%

Percutaneous Cardiopulmonary Support for the Treatment of Acute Pulmonary Embolism: Summarized Review of the Literature in Japan Including Our Own Experience

Sakuma

Nakamura

Yamada

et al. 2009

Annals of Vascular Diseases

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“…As can be seen in Table 3 , in the developed world, venous thromboembolism is a common cause of maternal mortality. 3,77 In a patient suspected to have a pulmonary embolism, CPR can cause liver lacerations if the liver is swollen from venous congestion, 78 and in such cases, superior hand placement for CPR should be considered. If pulmonary embolism is the suspected cause of cardiac arrest, thrombolysis should be administered according to the standard (nonpregnant) cardiac arrest protocol.…”

Section: Etiology Of Cardiac Arrest In Pregnancymentioning

confidence: 99%

“…9 Pulmonary embolectomy has also been used successfully for massive pulmonary embolism following cesarean section. 78…”

Section: Etiology Of Cardiac Arrest In Pregnancymentioning

confidence: 99%

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When the Heart Stops

Ramsay

Paglia

Bourjeily

2012

J Intensive Care Med

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Cardiac arrest is a rare occurrence in pregnancy and may be related to obstetric or medical causes. Pregnancy is associated with profound physiologic changes that prepare the gravida for the challenges of labor and delivery, and resuscitation of the pregnant patient needs to take these changes into consideration. Cardiac output and plasma volume increase in pregnancy and distribute differently with the uterine circulation receiving approximately 17% of the total cardiac output. On the other hand, cardiac output is sensitive to positional changes in the second half of pregnancy but may improve with a lateral tilt of the gravida. Both oxygen reserve and upper airway size decrease in pregnancy, leading to difficulties surrounding airway management. Changes in the volume of distribution, renal and hepatic clearance may impact drug effects and need to be recognized. This review will discuss an overview of pregnancy physiology that is relevant to cardiac resuscitation, detail the challenges in the various resuscitative steps including a synopsis on perimortem delivery, and describe obstetric and nonobstetric causes of mortality and cardiac arrest in pregnancy.

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“…Treatment options for PE associated with pregnancy are thrombolysis, percutaneous thrombectomy, surgical thrombectomy, extracorporeal membrane oxygenation (ECMO), and anticoagulation therapy [3,4]. In postpartum periods, the risk of bleeding following these treatments is high, and many authors have reported hemoperitoneum or acute vaginal bleeding following such treatments [5][6][7][8]. However, there have been no reports about massive hematoma following postpartum PE in the Retzius space caused by anticoagulation therapy that were severe enough to cause acute kidney injury.…”

Section: Introductionmentioning

confidence: 99%

Obstructive uropathy associated with a Retzius space hematoma following postpartum pulmonary embolism

Song¹,

Park²,

Lee³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: To report on a case of acute renal failure associated with a Retzius space hematoma that had been extended to retroperitoneal space, following pulmonary embolism treatment in the postpartum period. Case report: A 30-year-old woman was transferred to the hospital for syncope on the first postoperative day following cesarean section. There were no active vaginal bleeding or intra-abdominal bleeding. On diagnosis of pulmonary embolism, she was treated with extracorporeal membrane oxygenation with heparinization. On day 4, ultrasonography showed newly developed hematoma at the anterior side of the uterus, and transarterial embolization was performed. On day 5, she developed acute kidney injury but there were no increase in size of the hematoma on ultrasonography. She recovered after 3 days of renal replacement therapy. However, on day 10, she showed tachycardia and increased serum creatinine. Computed tomography revealed not only a 15-cm hematoma anterior to the uterus, but also another 17-cm hematoma in the retroperitoneal space under the left kidney. Exploratory laparotomy was performed for obstructive uropathy and hematomas were evacuated. The patient's vital sign stabilized one day following surgery. Conclusion: When treating postpartum patients with pulmonary embolism, physicians should be aware of the possibility of a concealed hemorrhage in the Retzius space and of subsequent kidney injury.

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Postcesarean Pulmonary Embolism, Sustained Cardiopulmonary Resuscitation, Embolectomy, and Near-Death Experience

Abstract: Massive pulmonary embolism is a potentially treatable catastrophic event after cesarean delivery, even if continuous cardiopulmonary resuscitation is required until life-saving embolectomy is done.

Cited by 10 publications

References 5 publications

Percutaneous Cardiopulmonary Support for the Treatment of Acute Pulmonary Embolism: Summarized Review of the Literature in Japan Including Our Own Experience

Percutaneous Cardiopulmonary Support for the Treatment of Acute Pulmonary Embolism: Summarized Review of the Literature in Japan Including Our Own Experience

When the Heart Stops

Obstructive uropathy associated with a Retzius space hematoma following postpartum pulmonary embolism

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