SIMULTANEOUS USE OF MECHANICAL CIRCULATORY SUPPORT AND CATHETER-DIRECTED THROMBOLYSIS FOR MASSIVE PULMONARY EMBOLISM

Right ventricular failure secondary to pulmonary embolism is associated with morbidity and death. The Impella RP System has often been used for percutaneous mechanical circulatory support in patients with right ventricular failure from other causes, including myocardial infarction, cardiac surgery, and left ventricular assist device implantation. We report 2 cases of massive pulmonary embolism in which combined Impella RP use and ultrasound-assisted catheter-directed thrombolysis effectively treated shock caused by right ventricular failure and contributed to successful outcomes. To our knowledge, only one other patient with this indication had been treated with the Impella RP device.

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Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices

Texas Heart Institute Journal ◽

10.14503/thij-19-7025 ◽

2020 ◽

Vol 47 (3) ◽

pp. 202-206

Author(s):

Aneil Bhalla ◽

Robert Attaran

Keyword(s):

Pulmonary Embolism ◽

Extracorporeal Membrane Oxygenation ◽

Right Ventricular ◽

Mechanical Circulatory Support ◽

Massive Pulmonary Embolism ◽

Circulatory Support ◽

Ventricular Assist ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Va Ecmo

Mechanical circulatory support may help patients with massive pulmonary embolism who are not candidates for systemic thrombolysis, pulmonary embolectomy, or catheter-directed therapy, or in whom these established interventions have failed. Little published literature covers this topic, which led us to compare outcomes of patients whose massive pulmonary embolism was managed with the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a right ventricular assist device (RVAD). We searched the medical literature from January 1990 through September 2018 for reports of adults hospitalized for massive or high-risk pulmonary embolism complicated by hemodynamic instability, and who underwent VA-ECMO therapy or RVAD placement. Primary outcomes included weaning from mechanical circulatory support and discharge from the hospital. We found 16 reports that included 181 patients (164 VA-ECMO and 17 RVAD). All RVAD recipients were successfully weaned from support, as were 122 (74%) of the VA-ECMO patients. Sixteen (94%) of the RVAD patients were discharged from the hospital, as were 120 (73%) of the VA-ECMO patients. Of note, the 8 RVAD patients who had an Impella RP System were all weaned and discharged. For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.

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Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548420957451 ◽

2020 ◽

Vol 14 ◽

pp. 117954842095745

Author(s):

Arda Akoluk ◽

Usman Mazahir ◽

Steven Douedi ◽

Adel Aziz ◽

Aref Obagi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Bleeding Risk ◽

Massive Pulmonary Embolism ◽

Response Monitoring ◽

Circulatory Support ◽

Systemic Thrombolysis ◽

First Case ◽

Catheter Directed Thrombolysis ◽

Novel Coronavirus ◽

Bail Out

Background: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. Case Presentation: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. Conclusions: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

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Right ventricular assist devices for mechanical circulatory support in acute massive pulmonary embolism: a single centre experience

10.1183/13993003.congress-2021.oa2594 ◽

2021 ◽

Author(s):

Chinthaka Samaranayake ◽

Benjamin Garfield ◽

Sam Seitler ◽

Simon Davies ◽

Stephane Ledot ◽

...

Keyword(s):

Pulmonary Embolism ◽

Right Ventricular ◽

Mechanical Circulatory Support ◽

Massive Pulmonary Embolism ◽

Ventricular Assist Devices ◽

Circulatory Support ◽

Single Centre ◽

Ventricular Assist ◽

Assist Devices ◽

Single Centre Experience

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Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

Journal of Clinical Medicine ◽

10.3390/jcm10153376 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3376

Author(s):

Raphaël Giraud ◽

Matthieu Laurencet ◽

Benjamin Assouline ◽

Amandine De Charrière ◽

Carlo Banfi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Retrospective Study ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Massive Pulmonary Embolism ◽

Bleeding Complications ◽

Circulatory Support ◽

Adequate Treatment ◽

Number Of Patients ◽

Va Ecmo

Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65–91.57, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, p = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.

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COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽

10.1024/0301-1526/a000880 ◽

2020 ◽

Vol 49 (4) ◽

pp. 333-337 ◽

Cited By ~ 3

Author(s):

Francisco Leonardo Galastri ◽

Leonardo Guedes Moreira Valle ◽

Breno Boueri Affonso ◽

Marcela Juliano Silva ◽

Rodrigo Gobbo Garcia ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Dynamic Process ◽

Therapeutic Option ◽

Massive Pulmonary Embolism ◽

Percutaneous Intervention ◽

Thromboembolic Events ◽

Emergency Center ◽

Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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