Morphologic characteristics of central pulmonary thromboemboli predict haemodynamic response in massive pulmonary embolism.
OBJECTIVE
On hospital admission, the morphology of the central pulmonary artery thromboemboli is an independent predictor of 30-day mortality in patients with massive pulmonary embolism (MPE). This may be due to the differential susceptibility of thromboemboli to thrombolysis. The aim of this study was to assess haemodynamic response to treatment in patients with MPE and morphologically different thromboemboli.


METHODS
Prospective observational study.


METHODS
An 11-bed closed medical ICU at a 860-bed community general hospital.


METHODS
Twelve consecutive patients with shock or hypotension due to MPE and central pulmonary thromboemboli detected by transesophageal echocardiography who were treated with thrombolysis between January 2000 through April 2002.


METHODS
Patients were divided into two groups according to the characteristics of detected central pulmonary thromboemboli: group 1, thrombi with one or more long, mobile parts; and group 2, immobile thrombi. Urokinase infusion was terminated when mixed venous oxygen saturation was stabilized above 60% for 15 min.


RESULTS
At 2 h, the total pulmonary vascular resistance index was reduced more in group 1 than group 2 [from 27+/-12 mmHg/(l.min.m(2)) to 14+/-6 mmHg/(l.min.m(2)) (-52%) vs 27+/-8 mmHg/(l.min.m(2)) to 23+/-10 mmHg/(l.min.m(2)) (-15%), respectively, P=0.04]. In group 1 thrombolysis was terminated earlier than group 2 (89+/-40 min vs 210+/-62 min, respectively, P= 0.0024). The cumulative dose of urokinase used in group 1 was lower than group 2 (1.7+/-0.3 M i.u. vs 2.7+/-0.5 M i.u., respectively, P= 0.023).


CONCLUSIONS
Haemodynamic stabilization is achieved faster in patients with mobile central thromboemboli detected by transesophageal echocardiography during MPE.
Podbregar
Matej
M
Department for Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000 Celje, Slovenia. Matej.Podbregar@guest.arnes.si
Voga
Gorazd
G
Krivec
Bojan
B
D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000379:methods; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D000925:Anticoagulants; D014568:Urokinase-Type Plasminogen Activator