Salvage of venoarterial extracorporeal membrane oxygenation following prolonged cardiopulmonary resuscitation and failure of catheter-directed thrombectomy for massive pulmonary embolism in a young patient

doi:10.5847/wjem.j.1920-8642.2023.014

World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (2): 161-164.doi: 10.5847/wjem.j.1920-8642.2023.014

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Salvage of venoarterial extracorporeal membrane oxygenation following prolonged cardiopulmonary resuscitation and failure of catheter-directed thrombectomy for massive pulmonary embolism in a young patient

Ge Yu¹, Dong-po Wei¹, Hui Xie¹, Jian Lu¹, Jun-li Zhao², Shuang Li³(), Wei Chen³, Rui-lan Wang¹

¹Department of Emergency and Critical Care Medicine, Shanghai General Hospital (Shanghai First People’s Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
²Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
³Department of Cardiology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai 200434, China

Received:2022-05-21 Online:2023-03-03 Published:2023-03-01
Contact: Shuang Li E-mail:1210874@tongji.edu.cn

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Abstract

Ge Yu, Dong-po Wei, Hui Xie, Jian Lu, Jun-li Zhao, Shuang Li, Wei Chen, Rui-lan Wang. Salvage of venoarterial extracorporeal membrane oxygenation following prolonged cardiopulmonary resuscitation and failure of catheter-directed thrombectomy for massive pulmonary embolism in a young patient[J]. World Journal of Emergency Medicine, 2023, 14(2): 161-164.

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References 11

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[2]	Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006; 113(4): 577-82. doi: 10.1161/CIRCULATIONAHA.105.592592 pmid: 16432055
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[5]	Lian TY, Lu D, Yan XX, Tan JS, Peng FH, Zhu YJ, et al. Association between congenital thrombophilia and outcomes in pulmonary embolism patients. Blood Adv. 2020; 4(23): 5958-65. doi: 10.1182/bloodadvances.2020002955
[6]	Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019; 54(3): 1901647. doi: 10.1183/13993003.01647-2019
[7]	Hockstein MA, Creel-Bulos C, Appelstein J, Jabaley CS, Stentz MJ. Institutional experience with venoarterial extracorporeal membrane oxygenation for massive pulmonary embolism: a retrospective case series. J Cardiothorac Vasc Anesth. 2021; 35(9): 2681-5. doi: 10.1053/j.jvca.2020.12.045 pmid: 33531193
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[9]	Meneveau N, Guillon B, Planquette B, Piton G, Kimmoun A, Gaide-Chevronnay L, et al. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicenter series of 52 cases. Eur Heart J. 2018; 39(47): 4196-204. doi: 10.1093/eurheartj/ehy464 pmid: 30137303
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Hospital day(s) and timepoints	Significant clinical events
Day 1, 22:30	Presented to ED of Shanghai General Hospital, diagnosed with acute massive PE
Day 2, 2:00-4:30	Pulmonary angiogram and the procedure of CDT (AngioJet^™ Thrombectomy System) and thrombolysis (urokinase 250,000 U) of the bilateral pulmonary arteries in the Cath Lab. He was deteriorated clinically, receiving incubation and intravenous norepinephrine and transferred to ICU. Mechanical ventilation (initial parameter: A/C mode, VT 480 mL, f 16 bpm, PEEP 5 cmH₂O, FiO₂ 70%)
Day 2, 5:30	Sudden cardiac arrest, restoration of spontaneous circulation after sustained CPR for 33 min
Day 2, 8:30	Initiation VA-ECMO: the cannulas were surgically inserted by trained cardiovascular surgeons with femoral- femoral (22F-18F) cannula. (initial parameter: pump speed 3,560 revolutions/min, blood flow 4.5 L/min, gas flow 3.5 L/min, FiO₂ 60%)
Day 2,12:30	Vasopressors were discontinued
Day 2,16:00	Ventilation parameters improved and BLA fall back to normal
Day 3, 20:30	Weaned from ECMO
Day 5	Received genetic tests of thrombophilia
Day 7	Weaned from mechanical ventilation and extubated
Day 12	Transferred to general medicine floor. Add Warfarin for anticoagulation
Day 14, 8:00-19:00	Conducted a repeat CTPA. Discharged and taken anticoagulation of Warfarin

Salvage of venoarterial extracorporeal membrane oxygenation following prolonged cardiopulmonary resuscitation and failure of catheter-directed thrombectomy for massive pulmonary embolism in a young patient

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