Successful management of hemodynamic instability secondary to saddle pulmonary embolism-induced cardiac arrest using VA-ECMO in advanced malignancy with brain metastases

Journal of Cardiothoracic Surgery

Case Report

Zhaojun Xu¹  Jianneng Pan¹  Xiaoyang Zhou¹  Bixin Chen¹ 

[1]Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, 315000, Ningbo, Zhejiang, China

关键词: Saddle pulmonary embolism;    Hemodynamic instability;    Cardiac arrest;    VA-ECMO;    Malignancy;    Metastases;   

DOI  :  10.1186/s13019-022-02044-w

 received in 2022-06-13, accepted in 2022-11-27,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSaddle 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 presentationA 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.ConclusionVA-ECMO may be a ‘bridging’ therapy to circulation recovery during reperfusion therapy for SPE-induced hemodynamic collapse in malignancy patients with brain metastases.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 1