Abstract 2623: Resuscitation using Percutaneous Cardiopulmonary Support for Massive Pulmonary Embolism
Background: Despite many therapeutic strategies being reported, mortality among patients with massive pulmonary embolism (PE) complicated by circulatory collapse still remains high. Although some researchers reported the effectiveness of extracorporeal life support in massive PE patients, resuscitation using percutaneous cardiopulmonary support (PCPS) has not been widely accepted yet.
Objective: To determine the effect of PCPS for patients suffering from massive PE complicated by circulatory collapse.
Methods: From January 1996 to May 2007, 11 patients with massive PE were treated with PCPS. The indications for PCPS were profound shock lasting more than 15 minutes despite of pharmacologic treatment or witnessed cardiac arrest. After PCPS placement, patients received thrombolytic therapy unless contraindicated. Anticoagulation with heparin was performed in all patients. Patients were divided into 2 groups according to survival discharge (Gr-S, n=8) or in-hospital death (Gr-D, n=3).
Results: 10 of 11 patients were successfully weaned off the PCPS. 8 patients had survival discharge and 6 were doing well as before at the time of discharge. The causes of death were as following: one for bleeding from the digestive tract, one for liver injury due to chest compression and one for subarachnoid hemorrhage. There were no differences in age, gender, time from collapse to PCPS placement, the duration of PCPS and the frequency of thrombolytic therapy. Out of hospital cardiac arrest had a tendency to be less frequent (25% vs 100%, p=0.06), and time requiring CPR before PCPS placement was significantly shorter in Gr-S compared with Gr-D (10.0 vs 49.2 min., p=0.006). Hemorrhagic complications occurred more frequently in Gr-D (0% vs 100%, p=0.006).
Conclusion: PCPS is a powerful device providing adequate oxygenation and stabilizing the hemodynamic status during cardiopulmonary resuscitation. Thus, PCPS is effective for improving the prognosis in patients suffering from profound shock and in-hospital cardiac arrest due to massive PE.