open access

Vol 88, No 1 (2020)
ORIGINAL PAPERS
Published online: 2020-02-25
Submitted: 2019-10-09
Accepted: 2020-01-12
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Extracorporeal life support after failure of thrombolysis in pulmonary embolism

Sven Kaese, Pia Lebiedz
DOI: 10.5603/ARM.a2020.0073
·
Pubmed: 32153003
·
Adv Respir Med 2020;88(1):13-17.

open access

Vol 88, No 1 (2020)
ORIGINAL PAPERS
Published online: 2020-02-25
Submitted: 2019-10-09
Accepted: 2020-01-12

Abstract

Introduction: Fulminant pulmonary embolism (PE) may lead to cardiogenic shock or cardiac arrest with high mortality rates (65%) despite treatment with thrombolysis. Patients not responding to this therapy might benefit from extracorporeal life support (ECLS). Only occasional case reports of ECLS in PE patients are available. We studied the use of ECLS after thrombolysis in patients suffering from refractory cardiogenic shock due to PE.
Material and methods: Patients who were admitted to our university intensive care unit (ICU) with PE, not responding to throm-bolysis, and who received subsequent ECLS treatment were studied.
Results: 12 patients with severe PE were included. 6 patients were admitted by emergency medical services, 5 patients were transferred to the ICU from other hospitals and one patient presented at the emergency department by herself. 11 of 12 patients suffered from cardiac arrest and needed cardiopulmonary resuscitation (CPR) before ECLS implantation. Three ECLS were im-planted during CPR and nine ECLS were implanted during emergency conditions in patients with cardiogenic shock. All patients received thrombolysis before implementation of ECLS. Mean duration of ICU treatment was 22.4 ± 23.0 days. Mean duration of ECLS therapy was 5.6 ± 6.5 days. Bleeding complications occurred in four patients. Complications directly related to the ECLS system occurred in two patients (overall complication rate 42%). Overall, 6 of 12 patients (50%) survived.
Conclusions: ECLS may be considered as a bailout therapy in PE patients not responding to prior definitive treatment such as thrombolysis. ECLS therapy seems to be feasible with an acceptable complication rate even after thrombolysis.

Abstract

Introduction: Fulminant pulmonary embolism (PE) may lead to cardiogenic shock or cardiac arrest with high mortality rates (65%) despite treatment with thrombolysis. Patients not responding to this therapy might benefit from extracorporeal life support (ECLS). Only occasional case reports of ECLS in PE patients are available. We studied the use of ECLS after thrombolysis in patients suffering from refractory cardiogenic shock due to PE.
Material and methods: Patients who were admitted to our university intensive care unit (ICU) with PE, not responding to throm-bolysis, and who received subsequent ECLS treatment were studied.
Results: 12 patients with severe PE were included. 6 patients were admitted by emergency medical services, 5 patients were transferred to the ICU from other hospitals and one patient presented at the emergency department by herself. 11 of 12 patients suffered from cardiac arrest and needed cardiopulmonary resuscitation (CPR) before ECLS implantation. Three ECLS were im-planted during CPR and nine ECLS were implanted during emergency conditions in patients with cardiogenic shock. All patients received thrombolysis before implementation of ECLS. Mean duration of ICU treatment was 22.4 ± 23.0 days. Mean duration of ECLS therapy was 5.6 ± 6.5 days. Bleeding complications occurred in four patients. Complications directly related to the ECLS system occurred in two patients (overall complication rate 42%). Overall, 6 of 12 patients (50%) survived.
Conclusions: ECLS may be considered as a bailout therapy in PE patients not responding to prior definitive treatment such as thrombolysis. ECLS therapy seems to be feasible with an acceptable complication rate even after thrombolysis.

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Keywords

pulmonary embolism; extracorporeal life support system; cardiopulmonary resuscitation; thrombolysis; right heart failure

About this article
Title

Extracorporeal life support after failure of thrombolysis in pulmonary embolism

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 1 (2020)

Pages

13-17

Published online

2020-02-25

DOI

10.5603/ARM.a2020.0073

Pubmed

32153003

Bibliographic record

Adv Respir Med 2020;88(1):13-17.

Keywords

pulmonary embolism
extracorporeal life support system
cardiopulmonary resuscitation
thrombolysis
right heart failure

Authors

Sven Kaese
Pia Lebiedz

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