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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
  • 7,091 View
  • 219 Download
  • 19 Web of Science
  • 19 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
  • 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
  • 14,055 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.2023;[Epub]     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
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
  • 2,974 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.

ACC : Acute and Critical Care