PMID- 34868870
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211207
IS  - 2213-0071 (Print)
IS  - 2213-0071 (Electronic)
IS  - 2213-0071 (Linking)
VI  - 34
DP  - 2021
TI  - Surgical pulmonary embolectomy on VA-ECMO.
PG  - 101551
LID - 10.1016/j.rmcr.2021.101551 [doi]
LID - 101551
AB  - Surgical pulmonary embolectomy is a procedure that is often used to rescue 
      patients with massive pulmonary embolism (PE) and circulatory collapse that have 
      failed or may not be ideal candidates for other systemic and endovascular 
      treatment modalities. This procedure typically involves a sternotomy and the use 
      of cardiopulmonary bypass (CPB), which requires full systemic anticoagulation. 
      Here, we report the case of a surgical pulmonary embolectomy performed on 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO) rather than CPB to 
      minimize systemic anticoagulation. The patient had suffered a cardiac arrest due 
      to a saddle PE and required VA-ECMO which was complicated by a concomitant 
      intracranial hemorrhage. The patient tolerated the surgical pulmonary embolectomy 
      performed on VA-ECMO without procedure-related complications, and the ECMO 
      support did not substantially complicate the technical performance of the 
      procedure. In contrast to surgical pulmonary embolectomy performed on CPB, 
      greater attention must be paid to volume status when performing the procedure on 
      VA-ECMO since there is no blood reservoir. This case suggests cardiopulmonary 
      support on ECMO as a viable strategy for surgical embolectomy in patients with 
      unstable PEs in whom thrombolysis or full systemic anticoagulation are 
      contraindicated.
CI  - (c) 2021 The Authors.
FAU - Steinhorn, Rachel
AU  - Steinhorn R
AD  - Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain 
      Medicine, United States.
FAU - Dalia, Adam A
AU  - Dalia AA
AD  - Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain 
      Medicine, United States.
FAU - Bittner, Edward A
AU  - Bittner EA
AD  - Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain 
      Medicine, United States.
FAU - Chang, Marvin G
AU  - Chang MG
AD  - Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain 
      Medicine, United States.
LA  - eng
PT  - Case Reports
DEP - 20211110
PL  - England
TA  - Respir Med Case Rep
JT  - Respiratory medicine case reports
JID - 101604463
PMC - PMC8626575
OTO - NOTNLM
OT  - ACT, activated clotting time
OT  - ASD, atrial septal defect
OT  - CI, cardiac index
OT  - CPB, cardiopulmonary bypass
OT  - CT, computed tomography
OT  - Cardiopulmonary bypass
OT  - Case report
OT  - EEG, electroencephalogram
OT  - Extracorporeal membrane oxygenation
OT  - ICU, intensive care unit
OT  - LPA, left pulmonary artery
OT  - MPA, main pulmonary artery
OT  - MPAP, mean pulmonary artery pressure
OT  - MRI, magnetic resonance imaging
OT  - PA, pulmonary artery
OT  - PE, pulmonary embolism
OT  - PERT, pulmonary embolism response team
OT  - PFO, patent foramen ovale
OT  - PTT, partial thromboplastin time
OT  - Pulmonary embolectomy
OT  - Pulmonary embolism
OT  - RPA, right pulmonary artery
OT  - SDH, subdural hemorrhage
OT  - TEE, transesophageal echocardiography
OT  - TPA, tissue plasminogen activator
OT  - VA-ECMO
OT  - VA-ECMO, venoarterial extracorporeal membrane oxygenation
COIS- None of the authors declare a conflict of interest.
EDAT- 2021/12/07 06:00
MHDA- 2021/12/07 06:01
PMCR- 2021/11/10
CRDT- 2021/12/06 09:17
PHST- 2021/05/30 00:00 [received]
PHST- 2021/10/07 00:00 [revised]
PHST- 2021/11/08 00:00 [accepted]
PHST- 2021/12/06 09:17 [entrez]
PHST- 2021/12/07 06:00 [pubmed]
PHST- 2021/12/07 06:01 [medline]
PHST- 2021/11/10 00:00 [pmc-release]
AID - S2213-0071(21)00213-6 [pii]
AID - 101551 [pii]
AID - 10.1016/j.rmcr.2021.101551 [doi]
PST - epublish
SO  - Respir Med Case Rep. 2021 Nov 10;34:101551. doi: 10.1016/j.rmcr.2021.101551. 
      eCollection 2021.