Treatment of massive pulmonary embolism utilizing a multidisciplinary approach: a case study.
Massive pulmonary embolism (PE) is associated, historically, with a high mortality rate.Treatment options include systemic anticoagulation, catheter-directed thrombolytic therapy, surgical embolectomy, fragmentation techniques, and catheter embolectomy. Extracorporeal membrane oxygenation (ECMO) repeatedly has demonstrated effectiveness in providing cardiopulmonary support for the patient with a massive PE too unstable to undergo thrombolysis or embolectomy. The present case study describes a morbidly obese patient, status post gastric bypass surgery, who presented with PE, and acute respiratory and cardiac failure. A description of the patient's management plan, which includes a simple, rapidly deployed ECMO system (Levitronix CentriMag And Jostra Quadrox D), systemic- and catheter-directed thrombolytic therapy and rheolytic thrombectomy (AngioJet Series 3000, Possis Medical, Minneapolis, MN).
Cardiovascular Perfusion Services, University of Michigan Hospitals, Ann Arbor, Michigan 48109-5863, USA. kegriff@umich.edu
Kevin E
KE
Griffith
Eric
E
Jenkins
Jonathan
J
Haft
D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
D005343:Fibrinolytic Agents