PMID- 25251898
OWN - NLM
STAT- MEDLINE
DCOM- 20150615
LR  - 20141013
IS  - 1399-6576 (Electronic)
IS  - 0001-5172 (Linking)
VI  - 58
IP  - 10
DP  - 2014 Nov
TI  - Peri-operative massive pulmonary embolism management: is veno-arterial ECMO a 
      therapeutic option?
PG  - 1280-6
LID - 10.1111/aas.12411 [doi]
AB  - Pulmonary embolism remains an important clinical problem with a high mortality 
      rate. The potential for sudden and fatal hemodynamic deterioration highlights the 
      need for a prompt diagnosis and appropriate intervention. The purpose of the 
      present case report is to describe a successful peri-operative veno-arterial 
      extra corporeal membrane oxygenation (VA-ECMO) implantation for assumed massive 
      pulmonary embolism associated with high hemodynamic instability and severe 
      hypoxemia. A 52-year-old female victim of a motorcycle accident had been operated 
      on for unstable fractures that required optimal repair. Despite subcutaneous 
      administration of 40 mg enoxaparin on day 0 and day 1, the patient developed a 
      massive pulmonary embolism leading to peri-operative pulseless activity. As 
      intravenous thrombolysis was strictly contraindicated, a VA-ECMO was successfully 
      implanted and permitted to stabilize the patient's hemodynamics. The hemodynamic 
      and respiratory status improved by day 3, and the ECMO was removed. A vena cava 
      filter was implanted before successful and definitive stabilization of the 
      femoral fracture and the L2 fracture on days 4 and 5. The patient was able to be 
      mobilized 2 days after the surgery and was transferred to a rehabilitation ward 
      on day 15. At that time, her cognitive functions had fully recovered. ECMO can 
      provide lifesaving hemodynamic and respiratory support in patients with massive 
      pulmonary embolism who are too unstable to tolerate other interventions, who have 
      failed other therapies or for whom other therapies are contraindicated.
CI  - (c) 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John 
      Wiley & Sons Ltd.
FAU - Pavlovic, G
AU  - Pavlovic G
AD  - Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland.
FAU - Banfi, C
AU  - Banfi C
FAU - Tassaux, D
AU  - Tassaux D
FAU - Peter, R E
AU  - Peter RE
FAU - Licker, M J
AU  - Licker MJ
FAU - Bendjelid, K
AU  - Bendjelid K
FAU - Giraud, R
AU  - Giraud R
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20140923
PL  - England
TA  - Acta Anaesthesiol Scand
JT  - Acta anaesthesiologica Scandinavica
JID - 0370270
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Accidents, Traffic
MH  - Anticoagulants/therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Femoral Fractures/surgery
MH  - Humans
MH  - Intraoperative Complications/*therapy
MH  - Middle Aged
MH  - Orthopedic Procedures
MH  - Perioperative Care/*methods
MH  - Pulmonary Embolism/*therapy
MH  - Spinal Fractures/surgery
MH  - Treatment Outcome
MH  - Vena Cava Filters
EDAT- 2014/09/25 06:00
MHDA- 2015/06/16 06:00
CRDT- 2014/09/25 06:00
PHST- 2014/08/19 00:00 [accepted]
PHST- 2014/09/25 06:00 [entrez]
PHST- 2014/09/25 06:00 [pubmed]
PHST- 2015/06/16 06:00 [medline]
AID - 10.1111/aas.12411 [doi]
PST - ppublish
SO  - Acta Anaesthesiol Scand. 2014 Nov;58(10):1280-6. doi: 10.1111/aas.12411. Epub 
      2014 Sep 23.