SESSION TITLE: Critical Care Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Massive Pulmonary Thromboembolism (PTE) is associated with high risk of mortality. There is very little time to resuscitate the patient for surgical embolectomy as the patient is usually in acute cor pulmonale with severe intractable hypotension. Many times the use of streptokinase or tissue plasminogen activator (TPA) at this stage leads to disseminated haemorrhage. In some cases anticoagulation may be contraindicated due to co-morbidities . In this life threatening situation we have found catheter directed embolectomy (CDE) followed by local infusion of TPA in pulmonary artery to be life saving .
CASE PRESENTATION: A 52yr old male was referred for sudden onset hypotension, severe breathlessness, hypoxia, and alteration of sensorium. Five days previously he had been operated and a total knee replacement had been performed. Twelve hours earlier he had complained of breathlessness and a CT Pulmonary angiogram had shown massive PTE for which heparin infusion had been started. He was intubated and wheeled into the cath lab where CDE was performed. After the aspiration of large clots from the pulmonary artery his condition improved rapidly. Through the catheter left in-situ, TPA was perfused for 48hours.He was discharged in stable condition one week later.
DISCUSSION: In the last two years 26 patients have been treated with CDE in our institution. We have noted a 100 % success rate. Only one patient expired secondary to cerebral hemorrhage. The mean procedure time was 26 minutes. There was more than 50 % drop in clot burden (25/26).The pulmonary artery pressure dropped more than 50% in 96% (25/26). In 92.3% (24/26) of patients post procedure SPO2 rose to more than 95 % whereas the mean SPO2 pre procedure was 59%. The average systemic MAP pre- procedure was 40 mm of Hg while post procedure it was more than 65 mm of Hg in all cases. The mean fall in hemoglobin was found to be 2.2gm%.No major post procedure complications were seen.
CONCLUSIONS: In patients with massive PTE who are in severe shock, CDE has proven to be a life-saving procedure.
Reference #1: Kuo WT,van den Bosch MA, Hofmann LV et al, Catheter directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis.Chest, 2008 Aug;134(2):250-4
Reference #2: Meneveau N, Seronde MF, Blond MC et al, Management of unsuccessful thrombolysis in acute massive ,tpulmonary embolism. Chest, 2006 Apr,129(4):1035-50
DISCLOSURE: The following authors have nothing to disclose: Deepak Rosha, Abha Pandey, Narinder Khanna
No Product/Research Disclosure Information