Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search

Search

Page Path
HOME > Search
10 "Pulmonary embolism"
Filter
Filter
Article category
Keywords
Publication year
Authors
Original Article
Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review
You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong
Acute Crit Care. 2019;34(2):148-154.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00500
  • 7,651 View
  • 223 Download
  • 21 Web of Science
  • 22 Crossref
AbstractAbstract PDF
Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

Citations

Citations to this article as recorded by  
  • Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence
    Samir Ali, Christiaan L. Meuwese, Xavier J. R. Moors, Dirk W. Donker, Anina F. van de Koolwijk, Marcel C. G. van de Poll, Diederik Gommers, Dinis Dos Reis Miranda
    Netherlands Heart Journal.2024; 32(4): 148.     CrossRef
  • Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence
    Romain Chopard, Raquel Morillo, Nicolas Meneveau, David Jiménez
    Hämostaseologie.2024; 44(03): 182.     CrossRef
  • Evidence-Based Management of Massive and Submassive Pulmonary Embolism
    Sara Al-Juboori, Tareq Alzaher, Hashem Al Omari, Sufyan Al Gammaz, Mazen Al-Qadi
    JAP Academy Journal.2024;[Epub]     CrossRef
  • Mechanical Support in High-Risk Pulmonary Embolism: Review Article
    Amer N. Kadri, Razan Alrawashdeh, Mohamad K. Soufi, Adam J. Elder, Zachary Elder, Tamam Mohamad, Eric Gnall, Mahir Elder
    Journal of Clinical Medicine.2024; 13(9): 2468.     CrossRef
  • Extracorporeal membrane oxygenation for large pulmonary emboli
    Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
    Baylor University Medical Center Proceedings.2023; 36(3): 314.     CrossRef
  • Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association
    Joshua B. Goldberg, Jay Giri, Taisei Kobayashi, Marc Ruel, Alexander J.C. Mittnacht, Belinda Rivera-Lebron, Abe DeAnda, John M. Moriarty, Thomas E. MacGillivray
    Circulation.2023;[Epub]     CrossRef
  • Life-threatening pulmonary embolism: overview and management
    Nizar Osmani, Jonathan Marinaro, Sundeep Guliani
    International Anesthesiology Clinics.2023; 61(4): 35.     CrossRef
  • Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis
    Jonathan Jia En Boey, Ujwal Dhundi, Ryan Ruiyang Ling, John Keong Chiew, Nicole Chui-Jiet Fong, Ying Chen, Lukas Hobohm, Priya Nair, Roberto Lorusso, Graeme MacLaren, Kollengode Ramanathan
    Journal of Clinical Medicine.2023; 13(1): 64.     CrossRef
  • Pulmonary ECMO-ism: Let’s add PEA to ECPR indications
    Zachary Shinar, Alice Hutin
    Resuscitation.2022; 170: 293.     CrossRef
  • Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report
    Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
    World Journal of Clinical Cases.2022; 10(12): 3899.     CrossRef
  • Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy
    Taylor C. Remillard, Zain Kassam, Maks Coven, Aditya Mangla, Zoran Lasic
    JACC: Case Reports.2022; 4(10): 576.     CrossRef
  • Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report
    Pei-Yu Hsu, En-Bo Wu
    World Journal of Clinical Cases.2022; 10(15): 5111.     CrossRef
  • Percutaneous mechanical thrombectomy and extracorporeal membranous oxygenation: A case series
    Haytham Mously, Jamal Hajjari, Tarek Chami, Tarek Hammad, Robert Schilz, Teresa Carman, Yakov Elgudin, Yasir Abu‐Omar, Marc P. Pelletier, Mehdi H. Shishehbor, Jun Li
    Catheterization and Cardiovascular Interventions.2022; 100(2): 274.     CrossRef
  • Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution
    Joonyong Jang, So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-taek Uh, Gae-Eil Jang, Wonho Chang, Bo Young Lee
    Tuberculosis and Respiratory Diseases.2022; 85(3): 249.     CrossRef
  • Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
    Benjamin Assouline, Marie Assouline-Reinmann, Raphaël Giraud, David Levy, Ouriel Saura, Karim Bendjelid, Alain Combes, Matthieu Schmidt
    Journal of Clinical Medicine.2022; 11(16): 4734.     CrossRef
  • Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis
    Romain Chopard, Peter Nielsen, Fabio Ius, Serghei Cebotari, Fiona Ecarnot, Hugo Pilichowski, Matthieu Schmidt, Benedict Kjaergaard, Iago Sousa-Casasnovas, Mehrdad Ghoreishi, Rajeev L. Narayan, Su Nam Lee, Gregory Piazza, Nicolas Meneveau
    European Respiratory Journal.2022; 60(5): 2102977.     CrossRef
  • Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis
    Luca Baldetti, Alessandro Beneduce, Lorenzo Cianfanelli, Giulio Falasconi, Luigi Pannone, Francesco Moroni, Angela Venuti, Stefania Sacchi, Mario Gramegna, Vittorio Pazzanese, Francesco Calvo, Guglielmo Gallone, Matteo Pagnesi, Alberto Maria Cappelletti
    Artificial Organs.2021; 45(6): 569.     CrossRef
  • Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series
    Maxwell A. Hockstein, Christina Creel-Bulos, Joshua Appelstein, Craig S. Jabaley, Michael J. Stentz
    Journal of Cardiothoracic and Vascular Anesthesia.2021; 35(9): 2681.     CrossRef
  • Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
    John Harwood Scott, Matthew Gordon, Robert Vender, Samantha Pettigrew, Parag Desai, Nathaniel Marchetti, Albert James Mamary, Joseph Panaro, Gary Cohen, Riyaz Bashir, Vladimir Lakhter, Stephanie Roth, Huaqing Zhao, Yoshiya Toyoda, Gerard Criner, Lisa Moor
    Critical Care Medicine.2021; 49(5): 760.     CrossRef
  • Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism
    Salma Hassan, Christina Fanola, Amy Beckman, Faqian Li, Andrew C. Nelson, Michael Linden, Joan D. Beckman
    Thrombosis Research.2020; 193: 207.     CrossRef
  • Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis
    Matteo Pozzi, Augustin Metge, Anthony Martelin, Caroline Giroudon, Justine Lanier Demma, Catherine Koffel, William Fornier, Pascal Chiari, Jean Luc Fellahi, Jean Francois Obadia, Xavier Armoiry
    Vascular Medicine.2020; 25(5): 460.     CrossRef
  • Evidence-Based Minireview: Advanced therapies and extracorporeal membrane oxygenation for the management of high-risk pulmonary embolism
    Radhika Gangaraju, Frederikus A. Klok
    Hematology.2020; 2020(1): 195.     CrossRef
Case Reports
Neurosurgery
Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table
Boohwi Hong, Seok Hwa Yoon, Soo-Yong Park, Seunghyun Song, Ann Youn, Ja Gyung Hwang
Acute Crit Care. 2019;34(1):86-91.   Published online February 20, 2017
DOI: https://doi.org/10.4266/acc.2016.00794
  • 14,452 View
  • 223 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

Citations

Citations to this article as recorded by  
  • Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions
    Lingzhong Meng, Mads Rasmussen, Arnoley S. Abcejo, Deyi M. Meng, Chuanyao Tong, Hong Liu
    Anesthesia & Analgesia.2024; 138(6): 1215.     CrossRef
  • Perioperative patient positioning following scalp tumor surgery: an anesthetic challenge
    Rajnish Kumar, Nishant Sahay, Shagufta Naaz, Ansarul Haq, Rajesh Kumar
    Ain-Shams Journal of Anesthesiology.2022;[Epub]     CrossRef
  • Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position
    DaviBrasil Khouri, MarinaAyres Delgado, JadsonLardy Lemes, MarcelaMorais Afonso Cruz
    Saudi Journal of Anaesthesia.2022; 16(4): 485.     CrossRef
  • Pulmonary thromboembolism due to venostasis induced by sitting position during clavicle and pelvic bone fracture surgery
    Soomin LEE, Boohwi HONG, Woosik HAN, Man-Shik SHIM, Yoon-Hee KIM, Seok-Hwa YOON
    Chirurgia.2021;[Epub]     CrossRef
Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?
Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee
Korean J Crit Care Med. 2016;31(1):63-67.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.63
  • 5,859 View
  • 59 Download
AbstractAbstract PDF
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -
Wooil Kwon, Ho Geol Ryu, Hannah Lee, Yongjae Yoo
Korean J Crit Care Med. 2013;28(1):59-63.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.59
  • 2,518 View
  • 24 Download
AbstractAbstract PDF
Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.
A Case of Massive Pulmonary Thromboembolism Associated with Ramsay Hunt Syndrome: A Case Report
Jong Hoo Lee, Seong Joo Koh, Gil Myeong Seong, Miok Kim, Jae Chun Lee, Sang Hoon Han, Jay Chol Choi, Yee Hyung Kim
Korean J Crit Care Med. 2011;26(4):267-271.
DOI: https://doi.org/10.4266/kjccm.2011.26.4.267
  • 3,118 View
  • 70 Download
AbstractAbstract PDF
Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.
Acute Pulmonary Embolism Due to Free-floating Right Atrial Thrombus in a Patient with Multiple Myeloma: A Case Report
Youn Yi Jo, Yong Seon Choi, Sa Ra So, Shin Ok Koh
Korean J Crit Care Med. 2011;26(1):24-28.
DOI: https://doi.org/10.4266/kjccm.2011.26.1.24
  • 2,581 View
  • 17 Download
AbstractAbstract PDF
Although venous thrombosis is one of the most frequent complications of malignant disease including multiple myeloma, massive pulmonary embolism is an uncommon complication. Free-floating intracardiac thrombus has been rarely reported as a cause of acute pulmonary embolism in patients with multiple myeloma. We report a case presenting acute pulmonary embolism due to free-floating right atrial thrombus in a patient with multiple myeloma.
Successful Embolectomy of a Pulmonary Saddle Embolism Post-cesarean Section Complicated by Cardiac Arrest: A Case Report
Jae Jun Lee, Jin Kim, Hyoung Soo Kim, Min Sun Kyung, Eu Sun Ro, Sung Mi Hwang, So Young Lim
Korean J Crit Care Med. 2009;24(3):164-167.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.164
  • 2,324 View
  • 20 Download
AbstractAbstract PDF
A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.
Original Article
Diagnosis of Right Ventricular Dysfunction in Acute Pulmonary Embolism with N-terminal Probrain Natriuretic Peptide (NT-proBNP)
Young Ju Lee
Korean J Crit Care Med. 2006;21(2):83-88.
  • 1,565 View
  • 16 Download
AbstractAbstract PDF
BACKGROUND
Patients with pulmonary embolism are at high risk of death because of right ventricular dysfunction (RVD) and mortality rate increases with worsening right ventricular dysfuction. The utility of N-terminal probrain natriuretic peptide (NT-proBNP) testing in the emergency department for diagnosing right ventricular dysfunction with pulmonary embolism and optimal cut-off points for its uses are not well established.
METHODS
Forty-nine consecutive patients with confirmed pulmonary embolism, who visited our emergency medical center from March 2005 to September 2006, were recruited. Patients with congestive heart failure and chronic renal failure were excluded from study enrollment. The diagnosis of right ventricular dysfunction was based on echocardiographic evidence of right ventricular dysfunction.
RESULTS
The mean age was 68+/-11 yr, and 71% of the patients were women. The median NT-proBNP level among 29 patients (59%) who had RVD was 1296 versus 250 pg/ml for those 20 patients (41%) who did not have RVD (p=0.01). The area under the receiver operating characteristic curve was 0.94 (95% CI of 0.89~0.98). At a cutoff of 400 pg/ml, NT-proBNP had a sensitivity of 97%, a specificity of 75%, and an overall accuracy of 88% for RVD (p=0.01). An NT-proBNP level <400 pg/ml was optimal for ruling out RVD, which was a negative predictive value of 94%. Increased NT- proBNP was the strong independent predictor of RVD (odds ratio 13, 95% CI 4.3-39.0, p=0.01).
CONCLUSIONS
NT-proBNP levels are frequently increased in patients with pulmonary embolism who have RVD than who did not have RVD. In acute pulmonary embolism, NT-proBNP elevation is highly predictive of RVD.
Case Reports
Pulmonary Embolism Detected in the General Ward after Operation: A Case Report
Se Hyun Lew, Jong Hun Jun, Hee Koo Yoo, Yong Ho Kim
Korean J Crit Care Med. 2004;19(1):38-41.
  • 1,689 View
  • 41 Download
AbstractAbstract PDF
Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.
Pulmonary Embolism Detected after Induction of the General Anesthesia: A Case Report
Sang Ho Choi, Young Mi Kim, Soo Kyung Lee
Korean J Crit Care Med. 2003;18(1):43-47.
  • 2,041 View
  • 47 Download
AbstractAbstract PDF
Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and its diagnosis may be difficult. In this case, we detected the pulmonary embolism after induction of the general anesthesia for operation of tibiofibular fracture. The patient has undergone operation for hemoperitoneum 19 days ago. The nonspecific cardiopulmonary symptoms occuring from minor pulmonary embolism should be sought during the preoperative anesthetic evaluation of patients at high risk for pulmonary embolism.

ACC : Acute and Critical Care