Thrombolytic therapy complemented by ECMO: successful treatment for a case of massive pulmonary thromboembolism with hemodynamic collapse

Abstract

Pulmonary thromboembolism (PTE) is a common clinical condition related to significant mortality. Furthermore, patients with PTE presenting with right heart thrombus show higher mortality due to rapid hemodynamic deterioration. But the optimal treatment of massive PTE is controversial although various methods have been developed and improved. Here, we presented a case of 56-yr-old woman with massive PTE showing hemodynamic collapse, who was successfully treated with extracorporeal membrane oxygenation (ECMO) adjunct to thrombolytic therapy even without thrombectomy. ECMO was useful for resuscitation and stabilization of the cardiopulmonary function. In conclusion, thrombolytic therapy complemented by ECMO may be an effective treatment option for acute massive PTE with hemodynamic instability.

Keywords: Extracorporeal Membrane Oxygenation, Percutaneous Cardiopulmonary Support; Pulmonary Thromboembolism; Thrombolysis.

Fig. 1

Initial transthoracic echocardiography (TTE) image. (A) D-shape of LV on parasternal short axis view. (B) Free-floating, whip-like right atrial (RA) mass (arrow) suggesting thrombus. RA, right atrium; LV, left ventricle; LA, left atrium; Ao, aorta.

Fig. 2

Initial computed tomography (CT) image.Large saddle thrombus in main pulmonary artery and deep vein thrombus of external iliac vein (arrow) were presented in CT with contrast enhancement.

Fig. 3

Follow up computed tomography (CT) image, 1 month after discharge. Pulmonary thrombus in main pulmonary artery and deep vein thrombus of external iliac vein were clearly disappeared.