Acoustic pulse thrombolysis complemented by ECMO improved survival in patients with high-risk pulmonary embolism
© 2022 Wiley Periodicals LLC..
BACKGROUND: The optimal treatment of high-risk pulmonary embolism (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 (APT).
METHODS: 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. A total of 12 (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after presentation. All patients exhibited acute symptoms, computed tomography 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 intensive care unit stay of 9.9 ± 1.6 days (range: 7-22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range: 11-44 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 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 the patients who have high-risk PE with circulatory collapse.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
|---|---|
| Enthalten in: |
Journal of cardiac surgery - 37(2022), 3 vom: 12. März, Seite 492-500 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Dumantepe, Mert [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Acoustic pulse thrombolysis |
|---|
| Anmerkungen: |
Date Completed 02.02.2022 Date Revised 31.05.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/jocs.16222 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM335551785 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM335551785 | ||
| 003 | DE-627 | ||
| 005 | 20231225230116.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/jocs.16222 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1118.xml |
| 035 | |a (DE-627)NLM335551785 | ||
| 035 | |a (NLM)35020205 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Dumantepe, Mert |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Acoustic pulse thrombolysis complemented by ECMO improved survival in patients with high-risk pulmonary embolism |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 02.02.2022 | ||
| 500 | |a Date Revised 31.05.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: The optimal treatment of high-risk pulmonary embolism (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 (APT) | ||
| 520 | |a METHODS: 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. A total of 12 (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after presentation. All patients exhibited acute symptoms, computed tomography evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality | ||
| 520 | |a RESULTS: Twenty-two patients survived to hospital discharge, with a mean intensive care unit stay of 9.9 ± 1.6 days (range: 7-22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range: 11-44 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 dose for survivor patients was 20.5 ± 1.6 mg | ||
| 520 | |a 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 the patients who have high-risk PE with circulatory collapse | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a acoustic pulse thrombolysis | |
| 650 | 4 | |a cardiac arrest | |
| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 650 | 4 | |a high-risk pulmonary embolism | |
| 650 | 7 | |a Tissue Plasminogen Activator |2 NLM | |
| 650 | 7 | |a EC 3.4.21.68 |2 NLM | |
| 700 | 1 | |a Ozturk, Cuneyd |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of cardiac surgery |d 1996 |g 37(2022), 3 vom: 12. März, Seite 492-500 |w (DE-627)NLM013294970 |x 1540-8191 |7 nnns |
| 773 | 1 | 8 | |g volume:37 |g year:2022 |g number:3 |g day:12 |g month:03 |g pages:492-500 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/jocs.16222 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 37 |j 2022 |e 3 |b 12 |c 03 |h 492-500 | ||