PMID- 36471400
OWN - NLM
STAT- MEDLINE
DCOM- 20221207
LR  - 20221214
IS  - 1749-8090 (Electronic)
IS  - 1749-8090 (Linking)
VI  - 17
IP  - 1
DP  - 2022 Dec 5
TI  - Successful management of hemodynamic instability secondary to saddle pulmonary 
      embolism-induced cardiac arrest using VA-ECMO in advanced malignancy with brain 
      metastases.
PG  - 296
LID - 10.1186/s13019-022-02044-w [doi]
LID - 296
AB  - BACKGROUND: Saddle pulmonary embolism (SPE) represents a rare type of venous 
      thromboembolism that frequently causes circulation collapse and sudden death. 
      While venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been well 
      established as a salvage treatment for SPE-induced circulatory shock, it is 
      infrequently administered in patients with advanced malignancy, especially those 
      with brain metastases, given the potential bleeding complications and an 
      uncertain prognosis. As far, there are rare case reports regarding the successful 
      management of hemodynamic instability secondary to SPE-induced cardiac arrest 
      using VA-ECMO in advanced malignancy patients with brain metastases. CASE 
      PRESENTATION: A 65-year-old woman presenting with cough and waist discomfort who 
      had a history of lung cancer with brain metastases was admitted to the hospital 
      to receive chemoradiotherapy. She suffered sudden cardiac arrest during 
      hospitalization and returned to spontaneous circulation after receiving a 10-min 
      high-quality cardiopulmonary resuscitation. Pulmonary embolism was suspected due 
      to the collapsed hemodynamics and a distended right ventricle identified by 
      echocardiography. Subsequent computed tomographic pulmonary angiography revealed 
      a massive saddle thrombus straddling the bifurcation of the pulmonary trunk. 
      VA-ECMO with adjusted-dose systemic heparinization was initiated to rescue the 
      unstable hemodynamics despite receiving thrombolytic therapy with alteplase. 
      Immediately afterward, the hemodynamic status of the patient stabilized rapidly. 
      VA-ECMO was successfully discontinued within 72 h of initiation without any 
      clotting or bleeding complications. She was weaned off invasive mechanical 
      ventilation on the 6th day of intensive care unit (ICU) admission and discharged 
      from the ICU 3 days later with good neurological function. CONCLUSION: VA-ECMO 
      may be a 'bridging' therapy to circulation recovery during reperfusion therapy 
      for SPE-induced hemodynamic collapse in malignancy patients with brain 
      metastases.
CI  - (c) 2022. The Author(s).
FAU - Pan, Jianneng
AU  - Pan J
AD  - Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese 
      Academy of Sciences, Ningbo, 315000, Zhejiang, China.
FAU - Zhou, Xiaoyang
AU  - Zhou X
AD  - Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese 
      Academy of Sciences, Ningbo, 315000, Zhejiang, China.
FAU - Xu, Zhaojun
AU  - Xu Z
AD  - Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese 
      Academy of Sciences, Ningbo, 315000, Zhejiang, China.
FAU - Chen, Bixin
AU  - Chen B
AD  - Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese 
      Academy of Sciences, Ningbo, 315000, Zhejiang, China. nbsdeyyicu@163.com.
LA  - eng
GR  - 2022-F16/Ningbo Key Support Medical Discipline/
GR  - 2021KY1027/Zhejiang Medicine and Health Science and Technology Project/
PT  - Case Reports
PT  - Journal Article
DEP - 20221205
PL  - England
TA  - J Cardiothorac Surg
JT  - Journal of cardiothoracic surgery
JID - 101265113
SB  - IM
MH  - Female
MH  - Humans
MH  - Aged
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - *Pulmonary Embolism/complications/therapy
MH  - Heart Arrest, Induced/adverse effects
MH  - Hemodynamics
MH  - *Brain Neoplasms/complications/therapy
PMC - PMC9720990
OTO - NOTNLM
OT  - Cardiac arrest
OT  - Hemodynamic instability
OT  - Malignancy
OT  - Metastases
OT  - Saddle pulmonary embolism
OT  - VA-ECMO
COIS- The authors declare that they have no competing interests.
EDAT- 2022/12/06 06:00
MHDA- 2022/12/15 06:00
PMCR- 2022/12/05
CRDT- 2022/12/05 23:58
PHST- 2022/06/13 00:00 [received]
PHST- 2022/11/27 00:00 [accepted]
PHST- 2022/12/05 23:58 [entrez]
PHST- 2022/12/06 06:00 [pubmed]
PHST- 2022/12/15 06:00 [medline]
PHST- 2022/12/05 00:00 [pmc-release]
AID - 10.1186/s13019-022-02044-w [pii]
AID - 2044 [pii]
AID - 10.1186/s13019-022-02044-w [doi]
PST - epublish
SO  - J Cardiothorac Surg. 2022 Dec 5;17(1):296. doi: 10.1186/s13019-022-02044-w.