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Acoustic Pulse Thrombolysis Complemented by ECMO Improved Survival in Patients with High-Risk Pulmonary Embolism
  • Mert Dumantepe,
  • Cuneyd Ozturk
Mert Dumantepe
Uskudar University

Corresponding Author:[email protected]

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Cuneyd Ozturk
Florence Nightingale Hospital
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Background: The optimal treatment of high-risk PE with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis. Method: From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. Twelve (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after the presentation. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results: Twenty-two patients survived to hospital discharge, with a mean ICU stay of 9.9 ± 1.6 days (range, 7 to 22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range, 11 to 44 days). Six patients died from refractory shock. Ninety-day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 ± 1.1 days and the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 in patients who survived to discharge. The mean tissue plasminogen activator (tPA) dose for survivor patients was 20.5 ± 1.6 mg. Conclusion: Patients with high-risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for patients who have high-risk PE with circulatory collapse.
05 Aug 2021Submitted to Journal of Cardiac Surgery
06 Aug 2021Assigned to Editor
06 Aug 2021Submission Checks Completed
18 Aug 2021Review(s) Completed, Editorial Evaluation Pending
29 Sep 2021Editorial Decision: Accept
Mar 2022Published in Journal of Cardiac Surgery volume 37 issue 3 on pages 492-500. 10.1111/jocs.16222