Acute and Critical Care

Original Articles

Neurology
Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea: Min Kim, Ji Sung Lee, Seong-Joon Lee, So Young Park, Jungyun Seo, Ji Man Hong, Hee-Kwon Park, Jae-Kwan Cha, Jeffrey L. Saver, Jin Soo Lee; Acute Crit Care. 2025;40(2):282-292. Published online April 11, 2025; DOI: https://doi.org/10.4266/acc.004248

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Background
The effectiveness of intravenous tissue plasminogen activator (IV tPA) in patients with large-vessel occlusion (LVO) receiving endovascular treatment (EVT) for acute ischemic stroke (AIS) has been questioned. We investigated IV tPA effectiveness in real-world AIS patients, including those with intracranial LVO receiving EVT.
Methods
We identified patients with AIS who presented to hospital with National Institutes of Health Stroke Scale ≥4 within 8 hours of symptom onset from the institutional stroke registry. The association of IV tPA use with effectiveness and safety outcomes was analyzed in overall enrolled AIS patients; LVO patients; and patients treated with EVT. The effect of IV tPA was assessed using multiple logistic regression.
Results
Among the 654 patients meeting study entry criteria, 238 (36.4%) received IV tPA and 416 (63.6%) did not. Multiple logistic regression analysis and shift analysis revealed IV tPA was associated with improved outcomes in overall enrolled AIS population, LVO, and EVT-treated subgroups. Among EVT-treated patients, IV tPA was associated with higher likelihood of ambulatory or better outcome (modified Rankin Scale 0–3) with odds ratio of 1.95 (P=0.03).
Conclusions
In this real-world study, IV tPA use was associated with improved outcomes for patients with AIS, including among LVO patients treated and not treated with EVT, in the contemporary mechanical thrombectomy era.

Citations

Citations to this article as recorded by

SMART-M24: A Prognostic Nomogram for Long-Term Mortality in Acute Ischemic Stroke Beyond 24 H from Symptom Onset
Soo-Hyun Park, Ji Sung Lee, Tae Jung Kim, Mi Sun Oh, Ji-Woo Kim, Kyungbok Lee, Kyung-Ho Yu, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko
Translational Stroke Research.2025; 16(6): 1975. CrossRef
Knowledge and experience of local emergency care staff on stroke recognition and acute care in the United Arab Emirates
Mohammed Alkuwaiti, Azhar Talal, Emad Masuadi, Ghada Albluwi, Abdulla Alkuwaiti, David Olukolade Alao
International Journal of Emergency Medicine.2025;[Epub] CrossRef

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

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Abstract 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

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Management of Pulmonary Embolism: A Single-Center Experience
R. Holt Hammons, Sibu P. Saha
Southern Medical Journal.2025; 118(1): 14. CrossRef
Surgical Embolectomy for tPA Refractory Pulmonary Embolism Requiring VA-ECMO: A Case Report and Literature Review
Olga Gomez Rojas, Moustafa Younis, Mindaugas Rackauskas, Philip Hess, William Ricks, Mohammad Aladaileh, Biplab K. Saha
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Yoh Arita, Kota Takaki, Hironori Orihashi, Katsukiyo Kitabayashi, Nobuyuki Ogasawara
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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
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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
Acute Pulmonary Embolism: Evidence, Innovation, and Horizons
Stanislav Henkin, Francisco Ujueta, Alyssa Sato, Gregory Piazza
Current Cardiology Reports.2024; 26(11): 1249. CrossRef
Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2
Kensuke Takabayashi, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamo
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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
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Nizar Osmani, Jonathan Marinaro, Sundeep Guliani
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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
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Zachary Shinar, Alice Hutin
Resuscitation.2022; 170: 293. CrossRef
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Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
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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
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Pei-Yu Hsu, En-Bo Wu
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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
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Joonyong Jang, So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-taek Uh, Gae-Eil Jang, Wonho Chang, Bo Young Lee
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Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
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Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism
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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

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Abstract 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

Spinous Process-Splitting Laminectomy Versus Conventional Laminectomy: A Short-Term Outcome Study
Ahmed K Basha, Hesham Radwan, Abdelmaksod Mohammed Mousa, Ahmed Nagaty, Abdelrahman Bakry, Eslam Hussein, Mohamed Ashraf Mahmoud, Mohammed Eid
Cureus.2026;[Epub] CrossRef
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
Davi Brasil Khouri, Marina Ayres Delgado, Jadson Lardy Lemes, Marcela Morais 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

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Abstract 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.

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