Resuscitation and Circulatory Support Using Extracorporeal Membrane Oxygenation for Fulminant Pulmonary Embolism

Abstract

Fulminant pulmonary embolism (PE) with circulatory collapse is associated with a high mortality rate due to acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation and circulatory support in the perioperative period is mandatory to prevent sudden death. Extracorporeal membrane oxygenation (ECMO) was recently introduced for extracorporeal life support in patients with circulatory collapse and has provided an excellent outcome. We report on the effectiveness of ECMO support for fulminant PE. Seven patients were placed on veno-arterial ECMO for circulatory collapse caused by fulminant PE refractory to conventional treatment. After resuscitation, all patients underwent pulmonary angiography, and thrombolytic therapy was administered in all 7 patients under ECMO support. Three patients who did not improve by thrombolysis underwent embolectomy with standard cardiopulmonary bypass. Two thrombolysis and 2 surgery patients were weaned from bypass and survived. The duration of support ranged from 18-168 h (mean = 67.8 +/- 67.1 h), with maximum bypass flow rates of 2.0-4.5 (mean = 3.5 +/- 0.9). There were no device-related complications during support. In total, 4 patients (57%) were successfully weaned from support and discharged from the hospital in good condition. All patients who survived required prolonged support (27, 82, 151, and 168 h). We conclude that resuscitation and circulatory support using ECMO can be effective, life-saving measures in cases of circulatory collapse caused by fulminant PE.

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

“…ECLS provides a fundamental advantage in the treatment of collapsed massive PE because it provides the ability to decompress the acutely overloaded right atrium and ventricle, increase aortic pressure and hence myocardial perfusion pressure, increase myocardial blood flow, reverse ischemia, and consequently improve RV function. 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.…”

“…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.…”

British Thoracic Society guidelines for the management of suspected acute pulmonary embolism

“…269 The value of extracorporeal membrane oxygenation in cardiac arrest due to PE is unclear. 270 • Thrombolysis is the first line treatment for massive…”

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

“…11 However, there are numerous published case reports of successful cannulation for ECLS during cardiopulmonary resuscitation in patients with severe pulmonary embolism when thrombolysis fails. [12][13][14] ECLS as a bridge to surgery ECLS devices restore the circulation and maintain the oxygenation of the organs in acute right ventricular failure and cardiogenic shock, allowing for stabilization prior to surgical embolectomy. Deehring described ECLS as a bridging option; extracorporeal stabilization with ECLS allows for successful bridging until surgical embolectomy.…”