Treatment of massive pulmonary embolism utilizing a multidisciplinary approach: a case study

Abstract

Massive pulmonary embolism (PE) is associated, historically, with a high mortality rate.Treatment options include systemic anticoagulation, catheter-directed thrombolytic therapy, surgical embolectomy, fragmentation techniques, and catheter embolectomy. Extracorporeal membrane oxygenation (ECMO) repeatedly has demonstrated effectiveness in providing cardiopulmonary support for the patient with a massive PE too unstable to undergo thrombolysis or embolectomy. The present case study describes a morbidly obese patient, status post gastric bypass surgery, who presented with PE, and acute respiratory and cardiac failure. A description of the patient's management plan, which includes a simple, rapidly deployed ECMO system (Levitronix CentriMag And Jostra Quadrox D), systemic- and catheter-directed thrombolytic therapy and rheolytic thrombectomy (AngioJet Series 3000, Possis Medical, Minneapolis, MN).

Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature

“…These have included relatively small numbers of patients (range: 1-21) and none have described ECMO being used in association with a multidisciplinary PERT. 3-16 In this report, we describe the presentation, management and outcomes of a consecutive series patients who presented with massive PE and required ECMO circulatory support after the establishment of an institutional PERT program.…”

Thrombolytic Therapy Complemented by ECMO: Successful Treatment for A Case of Massive Pulmonary Thromboembolism with Hemodynamic Collapse

“…However, mortality of surgical embolectomy in hemodynamically unstable patientis still high even though recent data have shown improved outcome (In-hospital mortality is 25% to 100% in patient with preoperative arrest) (9). Percutaneous catheter-directed thrombolysis or catheter thrombectomy is another treatment option (10, 11). Although these procedures are potentially effective, they take more time to apply and show poor outcome in patient with cardiovascular collapse (12).…”

Disseminated microvascular pulmonary tumor embolism from non-small cell lung cancer leading to pulmonary hypertension followed by sudden cardiac arrest

“…Chemotherapy may be the option for DMPTE, although the efficacy is low. ECMO has a limited role in treating patients with right side heart failure caused by DMPTE, although its role has been established in treating patients with right heart failure caused by severe pulmonary embolism [10][11][12]. ECMO is a tool for temporary support of heart and lung function by partial cardiopulmonary bypass.…”