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Case Reports
. 2022 May 18;4(10):576-580.
doi: 10.1016/j.jaccas.2022.03.028.

Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy

Taylor C Remillard  1 , Zain Kassam  1 , Maks Coven  2 , Aditya Mangla  1   2 , Zoran Lasic  1   2
Affiliations
Case Reports

Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy

Taylor C Remillard et al. JACC Case Rep. .

Abstract

Systemic thrombolytic therapy is frequently used in the treatment of massive pulmonary embolism. We describe a case of pulseless electrical activity arrest, refractory obstructive shock in the setting of massive pulmonary embolism despite tissue plasminogen activator that was successfully treated with catheter-directed aspiration thrombectomy. (Level of Difficulty: Intermediate.).

Keywords: CCL, cardiac catheterization laboratory; CDTE, catheter directed thrombectomy; PE, pulmonary embolism; PEA, pulseless electrical activity; SpO2, oxygen saturation; VA-ECMO, veno-arterial extracorporeal membrane oxygenation; catheter directed thrombectomy; pulmonary embolism; tPA, tissue plasminogen activator; thrombolytics.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Admission Electrocardiogram Electrocardiogram on admission demonstrating sinus tachycardia with left anterior fascicular block and nonspecific ST and T-wave abnormalities.
Figure 2
Figure 2
Admission Computed Tomography Angiography (A) Computed tomography angiography demonstrating saddle pulmonary embolism noted in the left main pulmonary artery (red arrow). (B to D) Pulmonary embolism in the right main pulmonary artery (yellow arrows) with extensive clot burden extending segmentally.
Figure 3
Figure 3
Pulmonary Angiography Before and After Aspiration Thrombectomy (A) Right pulmonary angiogram (RPA) in left anterior oblique view revealing extensive clot burden in the RPA (red arrows). (B) Left pulmonary angiogram (LPA) in the right anterior oblique highlighting clots in the LPA (yellow arrows). (C) RPA revealing near resolution of the pulmonary embolism after catheter directed thrombectomy using the 24-F FlowTriever. (D) LPA in the right anterior highlighting a similar excellent angiographic result.
Central Illustration
Central Illustration
Management of Massive PE Requiring Combination of Thrombolytics and Percutaneous Thrombectomy PE = pulmonary embolism; PEA = pulseless electrical activity; tPA = tissue plasminogen activator.
See this image and copyright information in PMC

References

    1. Konstantinides S.V., Meyer G., Becattini C., et al. ESC Scientific Document Group, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) Eur Heart J. 2020;41(4):543–603. - PubMed
    1. Kurkciyan I., Meron G., Sterz F., et al. Pulmonary embolism as cause of cardiac arrest. Arch Intern Med. 2000;160:1529–1535. - PubMed
    1. Oh Y.N., Oh D.K., Koh Y., et al. Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review. Acute Crit Care. 2019;34(2):148–154. - PMC - PubMed
    1. Camen S., Soffker G., Kluge S., et al. Massive pulmonary embolism with intra-hospital cardiac arrest and full recovery of right ventricular function after veno-arterial extracorporeal membrane oxygenation therapy: a case report. Eur Heart J Case Rep. 2020;4(4):1–6. - PMC - PubMed

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