Extracorporeal Membrane Oxygenation, Pulmonary Embolectomy, and Right Ventricular Assist Device for Massive Pulmonary Embolism

Carly L Lodewyks; Joseph M Bednarczyk; Owen T Mooney; Rakesh C Arora; Rohit K Singal

doi:10.1016/j.cjca.2017.03.021

Extracorporeal Membrane Oxygenation, Pulmonary Embolectomy, and Right Ventricular Assist Device for Massive Pulmonary Embolism

Can J Cardiol. 2017 Jul;33(7):950.e7-950.e9. doi: 10.1016/j.cjca.2017.03.021. Epub 2017 Mar 31.

Authors

Carly L Lodewyks¹, Joseph M Bednarczyk², Owen T Mooney², Rakesh C Arora³, Rohit K Singal⁴

Affiliations

¹ Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
² Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: [email protected].

PMID: 28578933
DOI: 10.1016/j.cjca.2017.03.021

Abstract

Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass. After 48 hours, the RVAD was removed, and the patient survived to discharge. ECMO and temporary RVAD to support surgical embolectomy are lifesaving therapeutic considerations.

Publication types

Case Reports

MeSH terms

Adult
Echocardiography
Embolectomy / methods*
Extracorporeal Membrane Oxygenation / methods*
Heart-Assist Devices*
Humans
Male
Pulmonary Embolism / diagnosis
Pulmonary Embolism / therapy*
Tomography, X-Ray Computed