Massive Pulmonary Embolism with Hemodynamic Compromise Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation

Authors

B. Akkanti, University of Texas Health Science Center at Houston, Division of Critical Care, Pulmonary and SleepFollow
S. Nathan, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
E. N. Centeno
K. Akasapu
P. Doshi, University of Texas Health Science Center at Houston, Division of Critical Care, Pulmonary and Sleep
R. Hussain
F. Raissi
A. Nascimbene, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
R. Srinivasan, University of Texas Health Science Center at Houston, Division of Critical Care, Department of Radiology
I. Rajapreyar, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
M. Patel, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
J. Patel, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
M. Akay, University of Texas Health Science Center at Houston, Division of Critical Care, Pulmonary and Sleep
P. Loyalka, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
B. Kar, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure
I. Gregoric, University of Texas Health Science Center at Houston, Center for Advanced Heart Failure

Peer Reviewed

1

Publication Date

10-12-2015

Document Type

Original Research

Abstract

Introduction: Cardiogenic shock that results from pulmonary embolus has a high mortality rate. Systemic thrombolysis is frequently used in submassive and massive pulmonary embolus and has been shown to restore circulation. However, in the event of impending or ongoing cardiac arrest, systemic thrombolysis or anticoagulation alone has not been always shown to be effective. Case reports have previously established that extracorporeal membrane oxygenation can effectively be used as an effective rescue strategy in cases of cardiac arrest as a result from massive pulmonary embolus. We report six cases of massive pulmonary embolism (PE), in which veno-arterial extracorporeal membrane oxygenation (VA ECMO) was utilized or used as a backup strategy with excellent outcomes. We highly recommend using this strategy at the bedside in a tertiary care facility where VA ECMO support is available.

Methods: This is a retrospective study of all patients that underwent VA ECMO or utilized VA ECMO at the bedside as a rescue strategy in the setting of massive PE. We abstracted relevant clinical information from patient charts for this review.

Results and analysis: Out of the 107 VA ECMO runs performed at our facility between 1 September 2013 and 31 December 2014, four patients utilized this strategy in the setting of massive PE with impending cardiac arrest; in two cases it was available to use as a backup strategy. All six patients (Table 1) had successful recovery with complete restoration of cognitive status, functional status, and without any clinical signs of right ventricular (RV) dysfunction on discharge.

DOI

http://dx.doi.org/10.13023/VAD.2015.17

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Recommended Citation

Akkanti, B.; Nathan, S.; Centeno, E. N.; Akasapu, K.; Doshi, P.; Hussain, R.; Raissi, F.; Nascimbene, A.; Srinivasan, R.; Rajapreyar, I.; Patel, M.; Patel, J.; Akay, M.; Loyalka, P.; Kar, B.; and Gregoric, I. (2015) "Massive Pulmonary Embolism with Hemodynamic Compromise Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation," The VAD Journal: Vol. 1, Article 20.
DOI: http://dx.doi.org/10.13023/VAD.2015.17
Available at: https://uknowledge.uky.edu/vad/vol1/iss1/20