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- Title
Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation.
- Authors
Tran, Douglas; Hays, Nicole; Shah, Aakash; Pasrija, Chetan; Cires‐Drouet, Rafael S.; Toursavadkohi, Shahab A.; Mazzeffi, Michael A.; Herr, Daniel L.; Madathil, Ronson J.; Gammie, James S.; Griffith, Bartley P.; Deatrick, Kristopher B.; Kaczorowski, David J.; Cires-Drouet, Rafael S
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
PULMONARY embolism; EXTRACORPOREAL membrane oxygenation; TISSUE plasminogen activator; THROMBOLYTIC therapy; CATHETERS; CARDIOVASCULAR disease related mortality
- Publication
Journal of Cardiac Surgery, 2021, Vol 36, Issue 8, p2685
- ISSN
0886-0440
- Publication type
journal article
- DOI
10.1111/jocs.15622