scholarly journals P684 Paradoxical cerebral infarction due to massive pulmonary embolism in extracorporeal cardiopulmonary resuscitation and surgical embolectomy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Shiota ◽  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Carotid Artery ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Infarction ◽  
Massive Pulmonary Embolism ◽  
Paradoxical Embolism ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Surgical Embolectomy ◽  
The Right

Abstract Introduction Paradoxical cerebral infarction is a mechanism of acute ischemic stroke; however, definitive images to diagnose paradoxical embolism are not often obtained. We report a case of paradoxical cerebral embolism complicated with cardiac arrest due to massive pulmonary embolism. Case report A 40-year-old man presented due to sudden-onset chest pain, and was admitted to our hospital. He was restless and had cold sweat; we could not measure blood pressure. Electrocardiography showed wide QRS complex with right bundle branch block, and T wave inversion in leads V1 and III. Transthoracic echocardiography showed diffuse severe left ventricular hypokinesis, with slightly better inferior wall motion compared to other segments. Few minutes after arriving, he experienced cardiac arrest; chest compression was initiated. He was transported to the catheter laboratory, and veno-arterial extracorporeal membrane oxygenation was initiated subsequently. To diagnose the cause of arrest, we performed coronary angiography, which revealed no occluded coronary artery. Pulmonary angiograms showed bilateral proximal pulmonary artery occlusion with massive thrombi (panel A). Surgical embolectomy was performed after cardiac team discussion. After ICU admission post-surgery, pericardial effusion was increased, and the blood drained continuously from the chest tube; a large amount of blood transfusion was required. Reopen chest haemostasis was utilised. After the second ICU admission, anisocoria was observed; subsequent computed tomography showed low density and midline shift in almost the entire left cerebral hemisphere (Panel B). Carotid duplex ultrasound revealed a large thrombus saddled at the left carotid artery bifurcation (Panel C and D). We rechecked the transthoracic echocardiogram at arrival to reveal the cause of the cerebral infarction, which showed the thrombus to be at the ascending aorta (Panel E). We thought that the thrombi had moved from the lower limb to the right atrium. The massive pulmonary embolism increased the pulmonary artery and right atrial pressure, resulting in the lower pressure of the left atrium compared to that of the right atrium. The thrombi passed through the patent foramen ovale into the left atrium, moved into the left ventricle, and embolised the left internal carotid artery (Panel F). He expired due to severe neurologic injury from brain herniation. Conclusion In this case, although the pulmonary embolism was massive and led to cardiac arrest, the deteriorated haemodynamics improved by extracorporeal cardiopulmonary resuscitation and surgical embolectomy. However, we could not rescue the patient because of the severe neurological injury due to paradoxical embolism. Paradoxical cerebral infarction in pulmonary embolism is rare; however, we should pay careful attention to early detection of paradoxical cerebral infarction in pulmonary embolism and treatment for return of the patient to the former lifestyle. Abstract P684 figure

scholarly journals Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Gerard O’Connor ◽  
Gareth Fitzpatrick ◽  
Ayman El-Gammal ◽  
Peadar Gilligan
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Right Heart ◽  
Tissue Plasminogen ◽  
End Tidal ◽  
The Right ◽  
High Level

More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect.

scholarly journals Surgical pulmonary embolectomy in a multi-trauma patient: One-center experience in the resource-limited setting

2020 ◽  
Vol 8 ◽  
pp. 2050313X2095375
Author(s):  
Phung Duy Hong Son ◽  
Nguyen Huu Uoc ◽  
Pham Huu Lu ◽  
Doan Quoc Hung ◽  
Hoang-Long Vo
Keyword(s):  
Pulmonary Embolism ◽  
Trauma Patient ◽  
Pulmonary Arteries ◽  
Massive Pulmonary Embolism ◽  
Pulmonary Embolectomy ◽  
Resource Limited ◽  
Good State ◽  
Surgical Embolectomy ◽  
Similar Resource ◽  
The Right

Pulmonary embolism, a serious complication after trauma, may cause sudden death. We discuss an unusual case of 65-year-old woman who had traffic accident with liver injury and open fracture of both tibia and fibula on the right side. She was diagnosed with massive pulmonary embolism on the second day after accident and successfully underwent emergency surgical embolectomy from bilateral pulmonary arteries. There were no postoperative complications. The patient’s good state of health was recorded after 13 months of surgery. Surgical pulmonary embolectomy for such a multi-trauma patient provides valuable experience not only for our institution but also for the countries having similar resource-limited conditions.

scholarly journals Outcome of surgical embolectomy in patients with massive pulmonary embolism with and without cardiopulmonary resuscitation

2017 ◽  
Vol 4 ◽  
pp. 241-244
Author(s):  
Reza Hajizadeh ◽  
Samad Ghaffari ◽  
Afshin Habibzadeh ◽  
Naser Safaei ◽  
Kamran Mohammadi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiopulmonary Resuscitation ◽  
Massive Pulmonary Embolism ◽  
Surgical Embolectomy

scholarly journals Double Bolus Alteplase Therapy during Cardiopulmonary Resuscitation for Cardiac Arrest due to Massive Pulmonary Embolism Guided by Focused Bedside Echocardiography

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hafiz B. Mahboob ◽  
Bruce W. Denney
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Case Reports ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Excellent Outcome ◽  
Hemodynamic Compromise ◽  
Bedside Echocardiography ◽  
Resuscitation Guidelines

Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR). There is no consensus on the subsequent dosing. We present a case in which two 50 mg boluses of t-PA were administered 20 minutes apart during CPR due to persistent hemodynamic compromise guided by bedside echocardiogram. The patient had an excellent outcome with normalization of cardiac function and no neurologic sequela. This case demonstrates the benefit of utilizing bedside echocardiography to guide administration of a second bolus of alteplase when there is persistent hemodynamic compromise despite achieving return of spontaneous circulation after the initial bolus, and there is evidence of persistent right ventricle dysfunction. Future trials are warranted to help establish guidelines for thrombolytic use in cardiac arrest to maximize safety and efficacy.

Extracorporeal cardiopulmonary resuscitation in a patient with fulminant pulmonary embolism refractory to intraarrest thrombolysis

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 163-165
Author(s):  
Guramrinder Singh Thind ◽  
Tarik Hanane ◽  
Alejandro Bribriesco ◽  
James Yun ◽  
Balaram Anandamurthy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Case Report ◽  
Mortality Rate ◽  
Cardiopulmonary Resuscitation ◽  
Salvage Therapy ◽  
Therapeutic Strategies ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Compression Device ◽  
Hospital Cardiac Arrest

Introduction: A fulminant pulmonary embolism is a potentially reversible cause of cardiac arrest with a reported mortality rate of up to 95%. Therapeutic strategies for fulminant pulmonary embolism continue to evolve. Case report: We present a case of a 38-year-old female who suffered an in-hospital cardiac arrest due to fulminant pulmonary embolism. Extracorporeal cardiopulmonary resuscitation (facilitated by the LUCAS™ mechanical chest compression device) was successfully performed in this patient following failure of intraarrest thrombolysis. Discussion: For the management of fulminant pulmonary embolism, utilization of clot-directed therapies, especially intraarrest thrombolysis, has garnered increasing traction and interest. However, this therapeutic approach has its limitations. Fortuitously, the emergence of extracorporeal cardiopulmonary resuscitation has added a new dimension to the treatment of fulminant pulmonary embolism. A protocolized approach to treatment can improve outcomes in these patients. Conclusion: Extracorporeal cardiopulmonary resuscitation can be used as a salvage therapy in patients with fulminant pulmonary embolism in whom intraarrest thrombolysis has failed.

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