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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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578970/full |
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| author | Fangfang Qiu Bingxin Song Lina Chen Jiayi Hong |
| author_facet | Fangfang Qiu Bingxin Song Lina Chen Jiayi Hong |
| author_sort | Fangfang Qiu |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-cdf00b8789a54307a236a5780eefd635 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-cdf00b8789a54307a236a5780eefd6352025-08-20T02:10:14ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15789701578970Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis?Fangfang Qiu0Bingxin Song1Lina Chen2Jiayi Hong3Department of Critical Care Medicine, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, ChinaDepartment of Respiratory and Critical Care Medicine, Center for Oncology Medicine, the Fourth Affiliated Hospital of School of Medicine and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, ChinaDepartment of Critical Care Medicine, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, ChinaDepartment of Critical Care Medicine, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, ChinaAcute 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.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578970/fullpulmonary embolism—diagnosisextracorporeal membrane oxygenation (ECMO)thrombolysiscardiac arrest (CA)disseminated intravascular coagulation (DIC) |
| spellingShingle | Fangfang Qiu Bingxin Song Lina Chen Jiayi Hong Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? Frontiers in Cardiovascular Medicine pulmonary embolism—diagnosis extracorporeal membrane oxygenation (ECMO) thrombolysis cardiac arrest (CA) disseminated intravascular coagulation (DIC) |
| title | Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? |
| title_full | Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? |
| title_fullStr | Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? |
| title_full_unstemmed | Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? |
| title_short | Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? |
| title_sort | case report does extracorporeal membrane oxygenation treatment for acute pulmonary embolism induced respiratory and cardiac arrest still require thrombolysis |
| topic | pulmonary embolism—diagnosis extracorporeal membrane oxygenation (ECMO) thrombolysis cardiac arrest (CA) disseminated intravascular coagulation (DIC) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578970/full |
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