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Pulmonary Vascular Disease: Pulmonary Vascular Disease: VTE |

Successful Resuscitation of Severely Compromised Patients With Acute Massive Pulmonary Embolism Using Endovascular or Surgical Embolectomy and ECMO Support FREE TO VIEW

Tsung-Po Tsai, PhD; Jung-Min Yu, MD; Su-Chin Tsao, NP; An-Hua Sun, MBA; Shih-Chen Tsai, MD; Heng Su, MD
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Chung Shan Medical University Hospital, Taichung, Taiwan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A528. doi:10.1016/j.chest.2016.02.550
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SESSION TITLE: Pulmonary Vascular Disease: VTE

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Acute massive pulmonary embolism (PE) is frequently a desperate situation, but rapid diagnosis and aggressive therapy with endovascular or surgical embolectomy supported by extracorporeal membrane oxygenation (ECMO) may be lifesaving. However, the management is not standardized. This report detailed our current experience with rapid diagnosis of massive PE patients and early ECMO support in severely compromised patients.

METHODS: Between June 2011 and September 2012, 6 female patients (aged from 23 to 76 years, with a mean of 53.3 years) were diagnosed as having massive PE with either acute irreversible oxygenation failure (n=6) or cardiac arrest (n=5). All patients required ECMO support. They were treated with surgical embolectomy (n=1), Angiojet aspiration (n=1), and endovascular embolectomy (mechanical or pharmacomechanical thrombectomy and/or thrombolysis) (n=4). All patients were evaluated as high risk using the simplified Pulmonary Embolism Severity Index (sPESI), and were classified and diagnosed with the aid of chest CT, echocardiogram, and pulmonary angiography.

RESULTS: One patient died from an ECMO cannula insertion complication of massive retroperitoneal hematoma and bleeding, and 2 patients expired due to multi-organ failure. Three were weaned from ECMO and were discharged; they were in good condition at follow-up.

CONCLUSIONS: Aggressive endovascular or surgical pulmonary embolectomy with ECMO support appears to be beneficial for massive PE with acute cardiopulmonary failure.

CLINICAL IMPLICATIONS: Aggressive endovascular or surgical pulmonary embolectomy with ECMO support appears to be beneficial for massive PE with acute cardiopulmonary failure.

DISCLOSURE: The following authors have nothing to disclose: Tsung-Po Tsai, Jung-Min Yu, Su-Chin Tsao, An-Hua Sun, Shih-Chen Tsai, Heng Su

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