Peripheral Extracorporeal Membrane Oxygenation: Comprehensive Therapy for High-Risk Massive Pulmonary Embolism
| Autor: | Cindy J. Yu, David Spielvogel, Paul C. Saunders, Steven L. Lansman, Ramin Malekan, Alan Gass, Kathy A. Brown |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Risk Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Femoral vein Embolectomy Extracorporeal Extracorporeal Membrane Oxygenation Axillary artery medicine.artery Extracorporeal membrane oxygenation Humans Medicine Oxygenator Aged Aged 80 and over Heparin business.industry Length of Stay Middle Aged medicine.disease Pulmonary embolism Surgery Pulmonary artery Female Pulmonary Embolism Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 94:104-108 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2012.03.052 |
| Popis: | Background Although commonly reserved as a last line of defense, experienced centers have reported excellent results with pulmonary embolectomy for massive and submassive pulmonary embolism (PE). We present a contemporary surgical series for PE that demonstrates the utility of peripheral extracorporeal membrane oxygenation (pECMO) for high-risk surgical candidates. Methods Between June 2005 and April 2011, 29 patients were treated for massive or submassive pulmonary embolism, with surgical embolectomy performed in 26. Four high-risk patients were placed on pECMO, established by percutaneously cannulating the right atrium through a femoral vein and perfusing by a Dacron graft anastomosed to the axillary artery. A small, extracorporeal, rotary assist device was used, interposing a compact oxygenator in the circuit, and maintaining anticoagulation with heparin. Results Extracorporeal membrane oxygenation was weaned in 3 of 4 patients after 5.3 days (5, 5, and 6), with normalization of right ventricular dysfunction and pulmonary artery pressure (44.0 ± 2.0 to 24.5 ± 5.5 mm Hg) by ECHO. Follow-up computed tomographies showed several peripheral, nearly resorbed emboli in 1 case and complete resolution in 2 others. The fourth patient, not improving after 10 days, underwent surgery where an embolic liposarcoma was extracted. For all 29 cases, hospital and 30-day mortality was 0% and all patients were discharged, with average postoperative length of stay of 15 days for embolectomy and 17 days for pECMO. Conclusions Heparin therapy with pECMO support is a rapid, effective option for patients who might benefit from pulmonary embolectomy but are at high risk for surgery. |
| Databáze: | OpenAIRE |
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