Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Embolism
2004; Lippincott Williams & Wilkins; Volume: 109; Issue: 20 Linguagem: Inglês
10.1161/01.cir.0000128541.23364.d0
ISSN1524-4539
Autores Tópico(s)Atrial Fibrillation Management and Outcomes
ResumoHomeCirculationVol. 109, No. 20Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Embolism Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBExtracorporeal Membrane Oxygenation Support for Acute Pulmonary Embolism Yoshio Misawa Yoshio MisawaYoshio Misawa Division of Cardiovascular Surgery, Jichi Medical School, Minami-kawachi, Tochigi, Japan, Originally published25 May 2004https://doi.org/10.1161/01.CIR.0000128541.23364.D0Circulation. 2004;109:e229To the Editor:We read with great interest a review paper titled "Acute Pulmonary Embolism, Part II: Risk Stratification, Treatment, and Prevention" by Goldhaber and associates in the December 2003 issue of the journal.1 The strategies for acute pulmonary embolism in their review are anticoagulation, inferior vena caval filters, thrombolysis, and embolectomy. They mention that for patients with contraindications to thrombolysis, catheter-based or surgical embolectomy should be considered if risk stratification indicates a high likelihood of an adverse outcome, and that a successful outcome hinges on an interdisciplinary team with round-the-clock availability.We have also experienced hemodynamically deteriorating patients with acute pulmonary embolism. A prompt and definite treatment is required for cases with life-threatening circulatory collapse. Immediate circulatory support by extracorporeal membrane oxygenation (ECMO) is our treatment strategy for such patients.2 In 2 cases, we found that ECMO helped to maintain hemodynamic stability during thrombolytic therapy. Case 1 was that of a 76-year-old woman who experienced sudden chest pain and respiratory distress after radiation therapy and intravenous hyperalimentation for lung cancer. An echocardiogram confirmed the diagnosis of pulmonary embolism. Immediately after circulatory collapse, ECMO was started at a flow of 2.5 L/min, followed by successful 25-hour support. Case 2 was that of a 43-year-old housewife who exhibited sudden respiratory distress and cardiac arrest 2 days after gastrectomy. A pulmonary artery perfusion scintigram under cardiopulmonary resuscitation showed a massive pulmonary embolus. Thrombolytic therapy with 240 000 U of urokinase brought about no clinical improvement. After a 4-hour cardiopulmonary resuscitation, ECOM was instituted; her subsequent hemodynamic condition remained stable at a flow of 1.5 to 3 L/min. However, after weaning from 5-day ECOM support, she died from severe brain damage.Pulmonary embolism often progresses rapidly to circulatory collapse with respiratory distress and lethal arrhythmias. An interdisciplinary team with round-the-clock availability might lead to successful clinical results in such cases. However, the deterioration can be too rapid to lead to an embolectomy. Not only as an adjuvant of thrombolytic therapy, but as a bridge to subsequent catheter-based or surgical embolectomy, ECMO can play an important role in the treatment of acute pulmonary embolism with circulatory collapse. We use a percutaneous cardiopulmonary support system (Capiox EBS, Terumo Ltd, Tokyo, Japan) for ECMO.3 The Capiox EBS can be percutaneously installed via the peripheral artery and vein in the groin. We recommend ECMO support as a strategy for a patient in circulatory collapse from pulmonary embolism. References 1 Goldhaber SZ, Elliott CG. Acute pulmonary embolism, part II: risk stratification, treatment, and prevention. Circulation. 2003; 108: 2834–2838.LinkGoogle Scholar2 Misawa Y, Fuse K, Yamaguchi T, et al. Mechanical circulatory assist for pulmonary embolism. Perfusion. 2000; 15: 527–529.CrossrefMedlineGoogle Scholar3 Misawa Y, Fuse K, Kawahito K, et al. Clinical experience with a new system, 'CAPIOX EBS'. Jpn J Artif Organs. 1998; 27: 578–581.Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ain D, Albaghdadi M, Giri J, Abtahian F, Jaff M, Rosenfield K, Roy N, Villavicencio-Theoduloz M, Sundt T and Weinberg I (2017) Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital, Vascular Medicine, 10.1177/1358863X17739697, 23:1, (60-64), Online publication date: 1-Feb-2018. Magarakis M, Macias A, Ghodsizad A and Salerno T (2018) Surgical Management of Cardiovascular Thrombotic Conditions Cardiovascular Thrombus, 10.1016/B978-0-12-812615-8.00025-9, (367-376), . Reeb J, Olland A, Renaud S, Kindo M, Santelmo N, Massard G and Falcoz P (2017) Principi e indicazioni dell'assistenza circolatoria e respiratoria extracorporea in chirurgia toracica, EMC - Tecniche Chirurgiche - Chirurgia Generale, 10.1016/S1636-5577(17)82113-1, 17:1, (1-18), Online publication date: 1-Nov-2017. Kumar Bhatia N, Dickert N, Samady H and Babaliaros V (2017) The use of hemodynamic support in massive pulmonary embolism, Catheterization and Cardiovascular Interventions, 10.1002/ccd.26872, 90:3, (516-520), Online publication date: 1-Sep-2017. Dolmatova E, Moazzami K, Cocke T, Elmann E, Vaidya P, Ng A, Satya K and Narayan R (2017) Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism, Heart & Lung, 10.1016/j.hrtlng.2016.11.005, 46:2, (106-109), Online publication date: 1-Mar-2017. Reeb J, Olland A, Renaud S, Kindo M, Santelmo N, Massard G and Falcoz P (2016) Principi e indicazioni dell'assistenza circolatoria e respiratoria extracorporea in chirurgia toracica, EMC - Tecniche Chirurgiche Torace, 10.1016/S1288-3336(16)79382-4, 20:1, (1-18), Online publication date: 1-Nov-2016. Jaber W, Fong P, Weisz G, Lattouf O, Jenkins J, Rosenfield K, Rab T and Ramee S (2016) Acute Pulmonary Embolism, Journal of the American College of Cardiology, 10.1016/j.jacc.2015.12.024, 67:8, (991-1002), Online publication date: 1-Mar-2016. Swol J, Buchwald D, Strauch J and Schildhauer T (2015) Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients – a case series, Perfusion, 10.1177/0267659115583682, 31:1, (54-59), Online publication date: 1-Jan-2016. Omar H, Miller J, Mangar D and Camporesi E (2013) Experience with extracorporeal membrane oxygenation in massive and submassive pulmonary embolism in a tertiary care center, The American Journal of Emergency Medicine, 10.1016/j.ajem.2013.08.013, 31:11, (1616-1617), Online publication date: 1-Nov-2013. Swol J, Buchwald D, Ewers A and Schildhauer T (2012) Venoarterielle extrakorporale Membranoxygenierung (ECMO)Arteriovenous extracorporeal membrane oxygenation (ECMO), Medizinische Klinik - Intensivmedizin und Notfallmedizin, 10.1007/s00063-012-0164-4, 108:1, (63-68), Online publication date: 1-Feb-2013. Faggian G, Onorati F, Chiominto B, Gottin L, Dan M, Ribichini F, Menon T, Santini F and Mazzucco A (2011) Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to and Support for Pulmonary Thromboendarterectomy in Misdiagnosed Chronic Thromboembolic Pulmonary Hypertension, Artificial Organs, 10.1111/j.1525-1594.2010.01182.x, 35:10, (956-960), Online publication date: 1-Oct-2011. Falcoz P and Capellier G (2010) Principi e indicazioni della ECMO nella patologia polmonare dell'adulto, EMC - Tecniche Chirurgiche Torace, 10.1016/S1288-3336(10)70422-2, 14:1, (1-14), Online publication date: 1-Jan-2010. Falcoz P and Capellier G (2009) Principes et indications de l'ECMO en pathologie pulmonaire de l'adulte, EMC - Techniques chirurgicales - Thorax, 10.1016/S1241-8226(09)47780-6, 4:2, (1-14), Online publication date: 1-Jan-2009. May 25, 2004Vol 109, Issue 20 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000128541.23364.D0PMID: 15159336 Originally publishedMay 25, 2004 PDF download Advertisement
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