Extracorporeal Membrane Oxygenation for Failed TPA Therapy of Pulmonary Embolism
Journal Title: Advancements in Cardiovascular Research - Year 2018, Vol 1, Issue 4
Abstract
Pulmonary embolism may cause cardiac arrest secondary to obstruction of blood flow. Traditional treatment strategies include anticoagulation, thrombolysis, and mechanical extraction. Some advocate for support with extra corporeal membrane oxygenation (ECMO); however, surgical therapies are contraindicated following thrombolytics. We describe the emergent use of peripheral ECMO following thrombolytic therapy for a saddle pulmonary embolism associated with multiple episodes of cardiac arrest. The patient was stabilized with peripheral ECMO, anticoagulated and subsequently weaned from ECMO without any major bleeding complications. The administration of thrombolytics should not be a contraindication for ECMO in patients with massive pulmonary embolism associated with hemodynamic instabilityA 61-year-old man presented to the emergency department complaining of chest pain for two days. The EKG indicated sinus tachycardia with a right bundle branch block and a prior inferior infarct. The patient underwent cardiac catheterization, which was negative. Upon examination, the patient was dyspneic, normotensive, nauseous and diaphoretic with cyanotic extremities. Past medical history was unremarkable. The patient developed respiratory distress, was intubated and underwent a transthoracic echocardiogram (TTE), which revealed severely diminished right ventricular systolic function and right ventricular dilation. Followup chest computed tomography (CT) with contrast revealed a large saddle embolus almost completely filling the left and right main pulmonary arteries and segmental branches. During admission to the CTICU in preparation for operative pulmonary embolectomy, the patient suffered cardiac arrest with pulseless electrical activity (PEA). tPA was administered for salvage a 50 mg IV bolus followed by 50mg infused over 90 minutes, but the patient to remained hemodynamically unstable. Despite high doses of inotropes, the patient suffered multiple episodes of cardiac arrest requiring cardiopulmonary resuscitation (CPR). A CentriMag (Thoratec Corporation, Pleasanton, CA) centrifugal pump and a Quadrox Softline coating oxygenator was utilized at the bedside via femoral-femoral arterio-venous cannulation.
Authors and Affiliations
Joshua Newman, David Park, Frank Manetta
Keywords
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- EP ID EP586956
- DOI 10.32474/ACR.2018.01.000116
- Views 108
- Downloads 0
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