Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation
© 2021 Wiley Periodicals LLC..
BACKGROUND: Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE.
METHODS: A review of all VA-ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in-hospital death, 90-day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO.
RESULTS: Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA-ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in-hospital death, and were alive at 90-day follow-up.
CONCLUSION: Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA-ECMO for PE, and allow for survival with RV recovery with minimal complications.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Journal of cardiac surgery - 36(2021), 8 vom: 30. Aug., Seite 2685-2691 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tran, Douglas [VerfasserIn] |
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| Links: |
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| Themen: |
9005-49-6 |
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| Anmerkungen: |
Date Completed 13.07.2021 Date Revised 10.02.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/jocs.15622 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM32533773X |
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| 245 | 1 | 0 | |a Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation |
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| 500 | |a Date Completed 13.07.2021 | ||
| 500 | |a Date Revised 10.02.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE | ||
| 520 | |a METHODS: A review of all VA-ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in-hospital death, 90-day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO | ||
| 520 | |a RESULTS: Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA-ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in-hospital death, and were alive at 90-day follow-up | ||
| 520 | |a CONCLUSION: Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA-ECMO for PE, and allow for survival with RV recovery with minimal complications | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a ECMO | |
| 650 | 4 | |a EKOS | |
| 650 | 4 | |a pulmonary embolism | |
| 650 | 7 | |a Heparin |2 NLM | |
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| 700 | 1 | |a Hays, Nicole |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Aakash |e verfasserin |4 aut | |
| 700 | 1 | |a Pasrija, Chetan |e verfasserin |4 aut | |
| 700 | 1 | |a Cires-Drouet, Rafael S |e verfasserin |4 aut | |
| 700 | 1 | |a Toursavadkohi, Shahab A |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzeffi, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Herr, Daniel L |e verfasserin |4 aut | |
| 700 | 1 | |a Madathil, Ronson J |e verfasserin |4 aut | |
| 700 | 1 | |a Gammie, James S |e verfasserin |4 aut | |
| 700 | 1 | |a Griffith, Bartley P |e verfasserin |4 aut | |
| 700 | 1 | |a Deatrick, Kristopher B |e verfasserin |4 aut | |
| 700 | 1 | |a Kaczorowski, David J |e verfasserin |4 aut | |
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