Pulmonary embolism after cesarean section and successful treatment with early application of extracorporeal membrane oxygenation system and anticoagulant agents

Ho, Yao-Kai; Wang, Chee-Ping; Wu, Yi-Liang; Lee, Tsung-Hsien; Ying, Tsung-Ho; Lee, Maw‐Sheng

doi:10.1016/j.tjog.2013.04.041

Cited by 11 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Procedures were thrombus aspiration, fragmentation of thrombi by catheter or rheolytic thrombectomies. In two women, this procedure appeared insufficient, leading to other treatments (ECMO for 6 days or surgical embolectomy ).…”

Section: Resultsmentioning

confidence: 99%

“…We found seven cases of severe PE treated with percutaneous fragmentation or thromboaspiration without thrombolysis (six massive PEs and one of uncertain severity; Table 2 and Table S2). Five had a diagnosis of PE before delivery [20,[37][38][39][40] and two in the early postpartum period [41,42]. Procedures were thrombus aspiration, fragmentation of thrombi by catheter or rheolytic thrombectomies.…”

Section: Percutaneous Catheter Thrombectomymentioning

confidence: 99%

See 1 more Smart Citation

Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review

Martillotti

Boehlen

Robert‐Ebadi

et al. 2017

Journal of Thrombosis and Haemostasis

108

View full text Add to dashboard Cite

Background Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. Methods We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or extracorporeal membrane oxygenation (ECMO), occurring during pregnancy or within 6 weeks of delivery. Main outcomes were maternal survival and major bleeding, premature delivery, and fetal survival and bleeding. Results We found 127 cases of severe PE (at least 83% massive; 23% with cardiac arrest) treated with at least one modality. Among 83 women with thrombolysis, survival was 94% (95% CI, 86-98). The risk of major bleeding was 17.5% during pregnancy and 58.3% in the postpartum period, mainly because of severe postpartum hemorrhages. Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated during pregnancy. Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95% CI, 71-95) and 20.0%, with fetal deaths possibly related to surgery in 20.0%. About half of severe postpartum PEs occurred within 24 h of delivery. Conclusions Published cases of thrombolysis for massive PE during pregnancy and the postpartum period suggest a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis, other therapeutic options (catheter [or surgical] thrombectomy, ECMO) may be considered if available.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Percutaneous Catheter Thrombectomymentioning

confidence: 99%

Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review

Martillotti

Boehlen

Robert‐Ebadi

et al. 2017

Journal of Thrombosis and Haemostasis

108

View full text Add to dashboard Cite

show abstract

“…ECMO was used to achieve hemodynamic stability followed by anticoagulation and finally catheter-directed thrombectomy. 34 In 2015, Yusuff and associates, conducted a systematic review of the literature on ECMO in patients with massive PE. There were no randomized control trials, however, they reviewed over 20 years of case reports on the topic and found an overall survival of 70.1%.…”

Section: Extracorporeal Membrane Oxygenation and Pulmonary Embolismmentioning

confidence: 99%

Massive Pulmonary Embolism: Extracorporeal Membrane Oxygenation and Surgical Pulmonary Embolectomy

Weinberg

Tapson

Ramzy

2017

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE. Randomized controlled human trials evaluating ECMO in this context have not been done, and its role has not been well-defined. The European Society of Cardiology 2014 acute PE guidelines briefly mention that ECMO can be used for massive PE as a method for hemodynamic support and as an adjunct to surgical embolectomy. The 2016 CHEST Antithrombotic Therapy for venous thromboembolism Disease guidelines do not mention ECMO in the management of massive PE. However, multiple case reports and small series cited benefit with ECMO for massive PE. Further, ECMO may facilitate stabilization for surgical embolectomy. Unfortunately, ECMO requires full anticoagulation to maintain the functionality of the system; hence, significant bleeding complicates its use in 35% of patients. Contraindications to ECMO include high bleeding risk, recent surgery or hemorrhagic stroke, poor baseline functional status, advanced age, neurologic dysfunction, morbid obesity, unrecoverable condition, renal failure, and prolonged cardiopulmonary resuscitation without adequate perfusion of end organs. In this review, we discuss management of massive PE, with an emphasis on the potential role for ECMO and/or surgical embolectomy.

show abstract

“…In the treatment of AFE, ECMO can be considered [10]. It is possible that the widespread use of ECMO during the 2009 H1N1 pandemic, and the publication of the CESAR trial have contributed to its worldwide growth [11].…”

Section: Discussionmentioning

confidence: 99%

Use of Extracorporeal Life Support in Postpartum in a Patient with Amniotic Fluid Embolism Complicated by Left Ventricular Failure and Disseminated Intravascular Coagulopathy

Tong¹,

Chin²,

Lim³

et al. 2019

Reprod Med Int

View full text Add to dashboard Cite

Pulmonary embolism after cesarean section and successful treatment with early application of extracorporeal membrane oxygenation system and anticoagulant agents

Cited by 11 publications

References 16 publications

Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review

Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review

Massive Pulmonary Embolism: Extracorporeal Membrane Oxygenation and Surgical Pulmonary Embolectomy

Use of Extracorporeal Life Support in Postpartum in a Patient with Amniotic Fluid Embolism Complicated by Left Ventricular Failure and Disseminated Intravascular Coagulopathy

Contact Info

Product

Resources

About