title: Peripheral extracorporeal membrane oxygenation: comprehensive therapy for high-risk massive pulmonary embolism.
abstract: BACKGROUND
  Although commonly reserved as a last line of defense, experienced centers have reported excellent results with pulmonary embolectomy for massive and submassive pulmonary embolism (PE). We present a contemporary surgical series for PE that demonstrates the utility of peripheral extracorporeal membrane oxygenation (pECMO) for high-risk surgical candidates.
  
  
  METHODS
  Between June 2005 and April 2011, 29 patients were treated for massive or submassive pulmonary embolism, with surgical embolectomy performed in 26. Four high-risk patients were placed on pECMO, established by percutaneously cannulating the right atrium through a femoral vein and perfusing by a Dacron graft anastomosed to the axillary artery. A small, extracorporeal, rotary assist device was used, interposing a compact oxygenator in the circuit, and maintaining anticoagulation with heparin.
  
  
  RESULTS
  Extracorporeal membrane oxygenation was weaned in 3 of 4 patients after 5.3 days (5, 5, and 6), with normalization of right ventricular dysfunction and pulmonary artery pressure (44.0 ± 2.0 to 24.5 ± 5.5 mm Hg) by ECHO. Follow-up computed tomographies showed several peripheral, nearly resorbed emboli in 1 case and complete resolution in 2 others. The fourth patient, not improving after 10 days, underwent surgery where an embolic liposarcoma was extracted. For all 29 cases, hospital and 30-day mortality was 0% and all patients were discharged, with average postoperative length of stay of 15 days for embolectomy and 17 days for pECMO.
  
  
  CONCLUSIONS
  Heparin therapy with pECMO support is a rapid, effective option for patients who might benefit from pulmonary embolectomy but are at high risk for surgery.
authors.affiliation: Section of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York 10595, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Malekan
authors.forename: Paul C
authors.initials: PC
authors.lastname: Saunders
authors.forename: Cindy J
authors.initials: CJ
authors.lastname: Yu
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Brown
authors.forename: Alan L
authors.initials: AL
authors.lastname: Gass
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017128:Embolectomy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D012306:Risk; D014057:Tomography, X-Ray Computed
chemical_list: D006493:Heparin