Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis?
Acute massive pulmonary embolism (PE) secondary to cardiac arrest (CA) is associated with extremely high mortality. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical life support modality; however, the safety and necessity of combined thrombolytic therapy remain controv...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578970/full |
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| Summary: | Acute massive pulmonary embolism (PE) secondary to cardiac arrest (CA) is associated with extremely high mortality. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical life support modality; however, the safety and necessity of combined thrombolytic therapy remain controversial. This study reports the clinical outcomes of two CA patients with acute PE treated with VA-ECMO: Case 1 underwent ECMO support without thrombolysis, receiving only heparin anticoagulation. Dynamic imaging evaluation demonstrated gradual thrombus resolution, leading to successful weaning from ECMO and subsequent recovery. Case 2 received immediate thrombolysis with alteplase 50 mg after ECMO cannulation but succumbed to severe bleeding complications—including cannulation site hemorrhage, disseminated intravascular coagulation (DIC), and hemorrhagic shock—within 24 h. For ECMO-treated PE patients with CA, clinical decisions should be based on etiological assessment, bleeding risk, and multimodal evaluations (e.g., imaging, coagulation function), prioritizing individualized reperfusion strategies (such as catheter-directed thrombectomy or surgical embolectomy) to improve prognosis. Although both cases described herein received VA-ECMO as salvage therapy, their divergent thrombolytic strategies resulted in contrasting clinical outcomes, prompting critical clinical reflections on risk-benefit balancing in this high-risk population. |
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| ISSN: | 2297-055X |