title: Massive pulmonary embolism requiring extracorporeal life support treated with catheter-based interventions.
abstract: When pulmonary embolism (PE) develops, circulatory collapse and hypoxia are caused at the same time. The rapid and proper use of extracorporeal life support (ECLS) can improve the mortality rate of patients with collapsed massive PE. No study has examined the influence of treatment that involved adding catheter based-intervention to ECLS with massive collapsed PE. Thirty-five patients with massive PE were examined, and 10 of these patients were placed on ECLS. Eight of the 10 patients placed on ECLS for massive PE were female, and the median age was 61 years. Seven patients had in-hospital onset PE and 3 patients out-of-hospital onset PE. Their underlying conditions were a cerebral infarction (3 patients), coronary artery disease (5 patients), collagen disease (one patient), postoperative state (3 patients), and lung disease (2 patients). Pulmonary angiographic findings showed that a filling defect or complete occlusion was observed in all 10 patients in the proximal lobular arteries, 6 of which had large thrombi stretching to the main pulmonary arteries. All patients underwent thrombolysis. Percutaneous catheter embolus fragmentation and/or thrombectomy were undertaken in 7 patients. All patients required red blood cell transfusion for cannulation site bleeding. The mean duration of ECLS bypass was 48 ± 44 hours. The 30 day mortality rate was 30%. The current study clarified the characteristics of patients with massive PE requiring ECLS. These patients have extensive pulmonary thromboemboli, thus, the aggressive use of catheter-based intervention appears to have beneficial effects for massive PE requiring ECLS.
authors.affiliation: Intensive and Cardiac Care Unit, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hosokawa
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Tokita
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Satoru
authors.initials: S
authors.lastname: Murata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tajima
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002404:Catheterization; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult