Commentary on: Successful use of extracorporeal membrane oxygenation for pulmonary embolism, prolonged cardiac arrest, post-partum: a cannulation dilemma

Perfusion ◽  
2015 ◽  
Vol 30 (2) ◽  
pp. 111-112
Author(s):  
P Fernandes
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Post Partum ◽  
Membrane Oxygenation

scholarly journals The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism

2017 ◽  
Vol 18 (4) ◽  
pp. 342-347 ◽  
Author(s):  
Alister Seaton ◽  
Luke E Hodgson ◽  
Ben Creagh-Brown ◽  
Adrian Pakavakis ◽  
Duncan LA Wyncoll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Short Term ◽  
Excellent Outcome ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Retrieval Team

A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.

scholarly journals Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

2020 ◽  
Author(s):  
Yen-Yu Chen ◽  
Yin-Chia Chen ◽  
Chia-Chen Wu ◽  
Hsu-Ting Yen ◽  
Kwan-Ru Huang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Course ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hospital Death ◽  
Close Monitoring ◽  
Membrane Oxygenation ◽  
Acute Pe

Abstract Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE.Methods: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated.Results: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

Abstract 13076: Refractory Out-of-Hospital Cardiac Arrest in Patients With Pulmonary Embolism and Use of Extracorporeal Membrane Oxygenation: Prague OHCA Study Subanalysis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jan Pudil ◽  
Jana Smalcova ◽  
Ondrej Smid ◽  
Daniel Rob ◽  
Michaela Hronova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Primary Outcome ◽  
Outcome Data ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Initial Settings ◽  
Patient Prognosis ◽  
Hospital Cardiac Arrest

Introduction: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) has poor outcome. Data about use of extracorporeal membrane oxygenation (ECMO) in PE are heterogenous and there is minimal evidence for its use in patients presenting with r-OHCA. Hypothesis: To describe in detail profile, initial settings of cardiac arrest (CA) and clinical course of patients with PE presenting with r-OHCA and its specifics in comparison to patients with r-OHCA of other cause. The special attention was paid to the use of ECMO and its potential benefit for patient prognosis. Methods: We reanalyzed subgroup of patients with PE from Prague OHCA study - a randomized control trial evaluating the effect of hyperinvasive approach including the use of ECMO in r-OHCA. Patients characteristics, the specifics of CA settings and the outcome were compared to the patients with other cause of r-OHCA. The neurologically favorable survival was then compared between PE patients randomized to Hyperinvasive and Standard arm of the study. Results: The PE was identified as a cause of CA in 24 (9.4 %) patients in Prague OHCA study. PE patients were more likely women (12 [50 %] vs 32 [13.8 %]) with non-shockable initial rhythm (23 [95.8 %] vs 77 [33.2 %]; P < 0.0001). The CA occurs more frequently after arrival of emergency medical service (14 [58.3 %], vs 22 [9.5 %]; P < 0.0001), had shorter time to hospital admission (median in minutes [IQR], 40 [34.5-57.8] vs 54 [46-64]; P = 0.01) with more severe acidosis at admission (median pH [IQR]; 6.83 [6.75-6.88] vs 6.98 [6.82-7.14] P = 0.0008). The primary outcome of patients with PE - CPC 1 or 2 at 180 days - was significantly worse (2 [8.3 %] vs 66 [28.4 %]; P = 0.049). There was non-significant difference in primary outcome - CPC 1 or 2 at 180 days - between PE patients in Hyperinvasive (12 [50%]) and Standard arm of the study (2 [16.7 %] vs 0; P = 0.24). Conclusion: The initial profile of patients and the settings of CA in patients with r-OHCA and PE differs from patients with other CA cause and their prognosis is significantly worse. The Hyperinvasive approach did not improved outcome in this subgroup of patients.

scholarly journals Massive pulmonary embolism with intra-hospital cardiac arrest and full recovery of right ventricular function after veno-arterial extracorporeal membrane oxygenation therapy: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Stephan Camen ◽  
Gerold Söffker ◽  
Stefan Kluge ◽  
Elvin Zengin
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Emergency Situation ◽  
Complete Recovery ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Membrane Oxygenation

Abstract Background Massive pulmonary embolism (PE) with shock constitutes a life-threatening disease, challenging physicians with the need for fast decision-making in an emergency situation. While thrombolytic treatment or thrombectomy are considered the treatment of choice in high-risk PE, these strategies might not be able to unload the right ventricle (RV) fast enough in some patients with severe cardiogenic shock. Case summary We present a case of a patient with massive bilateral central PE who presented in cardiogenic shock, rapidly deteriorating to cardiac arrest. After successful re-establishing spontaneous circulation, the patient remained highly unstable, necessitating a treatment strategy ensuring a quick stabilization of the circulation. Therefore, we decided to use veno-arterial extracorporeal membrane oxygenation (vaECMO) as a supportive strategy allowing for autolysis of the lung to dissolve the thrombi (bridge to recovery). We were able to wean the patient from vaECMO support within 4 days and documented a complete recovery of right ventricular in echocardiography before hospital discharge. Discussion The concept of vaECMO treatment alone might be a valuable alternative in selected patients with massive PE and cardiogenic shock, in whom thrombolytic therapy might not unload the RV fast enough.

scholarly journals Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yen-Yu Chen ◽  
Yin-Chia Chen ◽  
Chia-Chen Wu ◽  
Hsu-Ting Yen ◽  
Kwan-Ru Huang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Course ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hospital Death ◽  
Close Monitoring ◽  
Membrane Oxygenation ◽  
Acute Pe

Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. Methods Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. Results Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 h after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in ten patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

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