Successful use of a new hand-held ECMO system in cardiopulmonary failure and bleeding shock after thrombolysis in massive post-partal pulmonary embolism

Abstract

Massive pulmonary embolism (PE) leads to cardiogenic shock and is associated with mortality rates of up to 75%.1 We report on a 27-year-old mother in childbirth who developed a massive post-partal PE and cardiac arrest. Despite mechanical resuscitation, return of spontaneous circulation (ROSC) could not be achieved. After systemic thrombolysis, ROSC returned, but cardiopulmonary failure was persisting, complicated by massive bleeding shock. By using a newly developed, hand-held ECMO system, systemic blood flow and oxygenation were restored and emergency medical services for advanced surgical treatment (hysterectomy and pulmonary embolectomy) were possible. The patient recovered completely. We assume that this newly developed hand-held ECMO device enables rapid onset mechanical life support and improves the prognosis of patients in fatal conditions.

Keywords

cardiopulmonary resuscitation emergency medical service extracorporeal life support hand-held ECMO pulmonary embolism shock thrombolysis

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References

1 Dauphine C Omari B . Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg 2005; 79: 1240–1244.

2 Kawahito K Murata S Adachi H Ino T Fuse K . Resuscitation and circulatory support using extracorporeal membrane oxygenation for fulminant pulmonary embolism. Artificial Organs 2000; 24(6): 427–430.

3 Kolvekar SK Peek GJ Sosnowski AW Firmin RK . Extracorporeal membrane oxygenator for pulmonary embolism. Ann Thorac Surg 1997; 64(Sep): 883–884.

4 Tapson VF . Acute pulmonary embolism. N Engl J Med 2008; 358: 1037–1052.

5 Hief C Geppert A Haoula D . Thrombolysis in pulmonary embolism-status. J Kardiol 2004; 11: 497–502.

6 Maggio P Hemmila M Haft J . Extracorporeal life support for massive pulmonary embolism. J Trauma 2007; 62: 570–576.

7 Arlt M Philipp A Zimmermann M . First experiences with a new miniaturised life support system for mobile percutaneous cardiopulmonary bypass. Resuscitation 2008; 77: 345–350.

8 Spöhr F Böttiger BW . Thrombolysis in CPR. Current advantages in cardiopulmonary resuscitation. Minerva Anestesiol 2005; 71: 291–296.

9 Fam N Verma A . Thrombolysis of a massive pulmonary embolism. N Engl J Med 2002; 347(15): 1161.