Successful use of a new hand-held ECMO system in cardiopulmonary failure and bleeding shock after thrombolysis in massive post-partal pulmonary embolism

Massive pulmonary embolism (PE) leads to cardiogenic shock and is associated with mortality rates of up to 75%.1 We report on a 27-year-old mother in childbirth who developed a massive post-partal PE and cardiac arrest. Despite mechanical resuscitation, return of spontaneous circulation (ROSC) could not be achieved. After systemic thrombolysis, ROSC returned, but cardiopulmonary failure was persisting, complicated by massive bleeding shock. By using a newly developed, hand-held ECMO system, systemic blood flow and oxygenation were restored and emergency medical services for advanced surgical treatment (hysterectomy and pulmonary embolectomy) were possible. The patient recovered completely. We assume that this newly developed hand-held ECMO device enables rapid onset mechanical life support and improves the prognosis of patients in fatal conditions.

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Massive pulmonary embolism presenting initially as acute psychosis

BMJ Case Reports ◽

10.1136/bcr-2017-222018 ◽

2019 ◽

Vol 12 (4) ◽

pp. e222018

Author(s):

Michael Lawrenz Ferreras Co ◽

Arianne Clare Agdamag ◽

Marcus Juan Esteban ◽

Roselyn Mateo

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Life Support ◽

Massive Pulmonary Embolism ◽

Psychotic Symptoms ◽

Acute Psychosis ◽

Systemic Thrombolysis ◽

The Third ◽

Ventricular Response ◽

New Onset

This is a case of a 68-year-old man with Parkinson’s disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.

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Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2008.11.010 ◽

2009 ◽

Vol 5 (2) ◽

pp. 271-274 ◽

Cited By ~ 4

Author(s):

Rudolf A. Weiner ◽

Markos Daskalakis ◽

Sophia Theodoridou ◽

Sven Fassbender ◽

Karin Parutsch

Keyword(s):

Bariatric Surgery ◽

Pulmonary Embolism ◽

Postoperative Period ◽

Massive Pulmonary Embolism ◽

Systemic Thrombolysis

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Pulmonary Embolism Response Teams: A Novel Approach for the Care of Complex Patients With Pulmonary Embolism

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618812954 ◽

2018 ◽

Vol 24 (9_suppl) ◽

pp. 48S-55S ◽

Cited By ~ 7

Author(s):

Mateo Porres–Aguilar ◽

Javier E. Anaya-Ayala ◽

Gustavo A. Heresi ◽

Belinda N. Rivera-Lebron

Keyword(s):

Pulmonary Embolism ◽

The United States ◽

Cardiovascular Death ◽

Pulmonary Embolectomy ◽

Systemic Thrombolysis ◽

Cardiopulmonary Support ◽

Novel Approach ◽

Adoption And Implementation ◽

Complex Patients

Pulmonary embolism represents the third most common cause of cardiovascular death in the United States. Reperfusion therapeutic strategies such as systemic thrombolysis, catheter directed therapies, surgical pulmonary embolectomy, and cardiopulmonary support devices are currently available for patients with high- and intermediate-high–risk pulmonary embolism. However, deciding on optimal therapy may be challenging. Pulmonary embolism response teams have been designed to facilitate multidisciplinary decision-making with the goal to improve quality of care for complex cases with pulmonary embolism. Herein, we discuss the current role and strategies on how to leverage the strengths from pulmonary embolism response teams, its possible worldwide adoption, and implementation to improve survival and change the paradigm in the care of a potentially deadly disease.

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Systemic thrombolysis in a patient with massive pulmonary embolism and recent glioblastoma multiforme resection

BMJ Case Reports ◽

10.1136/bcr-2017-221578 ◽

2017 ◽

pp. bcr-2017-221578 ◽

Cited By ~ 1

Author(s):

Joshua Lampert ◽

Behnood Bikdeli ◽

Philip Green ◽

Matthew R Baldwin

Keyword(s):

Pulmonary Embolism ◽

Glioblastoma Multiforme ◽

Massive Pulmonary Embolism ◽

Systemic Thrombolysis

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Pulmonary embolectomy, heparin, and streptokinase: Their place in the treatment of acute massive pulmonary embolism

American Heart Journal ◽

10.1016/s0002-8703(77)80005-7 ◽

1977 ◽

Vol 93 (5) ◽

pp. 568-574 ◽

Cited By ~ 81

Author(s):

G.A.H. Miller ◽

R.J.C. Hall ◽

M. Paneth

Keyword(s):

Pulmonary Embolism ◽

Massive Pulmonary Embolism ◽

Pulmonary Embolectomy

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Salvage pulmonary thromboembolectomy for massive pulmonary embolism in a child presented with syncope and subsequent cardiac arrest

Cardiology in the Young ◽

10.1017/s1047951119001410 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1094-1096

Author(s):

Koray Ak ◽

Yasar Birkan ◽

Figen Akalın ◽

Deniz Günay

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Cardiopulmonary Arrest ◽

Massive Pulmonary Embolism ◽

High Index ◽

Exertional Dyspnoea ◽

Pulmonary Embolectomy ◽

High Index Of Suspicion

AbstractPulmonary embolism is frequently under-recognised in children and, therefore, a high index of suspicion should be exerted on patients with exertional dyspnoea, presyncope/syncope and unexplained cardiopulmonary arrest. We discuss a 10-year-old previously healthy girl who presented with syncope and subsequent cardiac arrest related to massive pulmonary embolism and was salvaged successfully by emergent pulmonary embolectomy.

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Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy

BMJ Case Reports ◽

10.1136/bcr-2019-234083 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234083 ◽

Cited By ~ 1

Author(s):

John Edward Ashbridge Taylor ◽

Chen Wen Ngua ◽

Matthew Carwardine

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Massive Pulmonary Embolism ◽

Spontaneous Circulation ◽

Postmortem Examination ◽

Right Heart ◽

Hypoxic Injury ◽

Injury Treatment ◽

Ct Brain ◽

Hospital Cardiac Arrest

Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.

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