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Resumé

INTRODUCTION:: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE.

METHODS:: We were called to 38 patients with PE, but two were assessed as untreatable. Seventeen were treated with cardiopulmonary resuscitation followed by veno-arterial ECMO. Nineteen were prepared for ECMO with sheaths in the femoral vessels and were intensively observed during diagnosis and treatment. Five of these patients later progressed to ECMO due to cardiac arrest during treatment with thrombolytic medication. Most of the patients were treated with heparin and thrombolytic medication, but if the medications were contraindicated, they were treated with either surgical thrombectomy or only with heparin awaiting spontaneous thrombolysis.

RESULTS:: Of the 36 patients we intended to treat, 25 (69%) survived one month and 20 survived one year (56%). Of the 22 patients treated with ECMO, 11 survived one month (50%) and 10 survived one year (45%).

DISCUSSION:: The treatment could have been more uniform. It seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE.

CONCLUSION:: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving.

OriginalsprogEngelsk
TidsskriftPerfusion
Vol/bind34
Udgave nummer6
Sider (fra-til)467–474
Antal sider8
ISSN0267-6591
DOI
StatusUdgivet - sep. 2019

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Extracorporeal Membrane Oxygenation
Oxygenation
Pulmonary Embolism
medication
Membranes
Heart Arrest
Therapeutics
Heparin
Hypothermia
Resuscitation
Thrombectomy
Cardiopulmonary Resuscitation
Thigh
Shock
Patient Care

Citer dette

@article{1b38166429ae42c2bc603e5f48ee333f,
title = "Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism",
abstract = "INTRODUCTION:: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE.METHODS:: We were called to 38 patients with PE, but two were assessed as untreatable. Seventeen were treated with cardiopulmonary resuscitation followed by veno-arterial ECMO. Nineteen were prepared for ECMO with sheaths in the femoral vessels and were intensively observed during diagnosis and treatment. Five of these patients later progressed to ECMO due to cardiac arrest during treatment with thrombolytic medication. Most of the patients were treated with heparin and thrombolytic medication, but if the medications were contraindicated, they were treated with either surgical thrombectomy or only with heparin awaiting spontaneous thrombolysis.RESULTS:: Of the 36 patients we intended to treat, 25 (69{\%}) survived one month and 20 survived one year (56{\%}). Of the 22 patients treated with ECMO, 11 survived one month (50{\%}) and 10 survived one year (45{\%}).DISCUSSION:: The treatment could have been more uniform. It seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE.CONCLUSION:: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving.",
author = "Benedict Kjaergaard and Kristensen, {Jens Hedegaard} and Sindby, {Jesper Eske} and {de Neergaard}, Susanne and Rasmussen, {Bodil Steen}",
year = "2019",
month = "9",
doi = "10.1177/0267659119830014",
language = "English",
volume = "34",
pages = "467–474",
journal = "Perfusion",
issn = "0267-6591",
publisher = "SAGE Publications",
number = "6",

}

TY - JOUR

T1 - Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism

AU - Kjaergaard, Benedict

AU - Kristensen, Jens Hedegaard

AU - Sindby, Jesper Eske

AU - de Neergaard, Susanne

AU - Rasmussen, Bodil Steen

PY - 2019/9

Y1 - 2019/9

N2 - INTRODUCTION:: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE.METHODS:: We were called to 38 patients with PE, but two were assessed as untreatable. Seventeen were treated with cardiopulmonary resuscitation followed by veno-arterial ECMO. Nineteen were prepared for ECMO with sheaths in the femoral vessels and were intensively observed during diagnosis and treatment. Five of these patients later progressed to ECMO due to cardiac arrest during treatment with thrombolytic medication. Most of the patients were treated with heparin and thrombolytic medication, but if the medications were contraindicated, they were treated with either surgical thrombectomy or only with heparin awaiting spontaneous thrombolysis.RESULTS:: Of the 36 patients we intended to treat, 25 (69%) survived one month and 20 survived one year (56%). Of the 22 patients treated with ECMO, 11 survived one month (50%) and 10 survived one year (45%).DISCUSSION:: The treatment could have been more uniform. It seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE.CONCLUSION:: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving.

AB - INTRODUCTION:: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE.METHODS:: We were called to 38 patients with PE, but two were assessed as untreatable. Seventeen were treated with cardiopulmonary resuscitation followed by veno-arterial ECMO. Nineteen were prepared for ECMO with sheaths in the femoral vessels and were intensively observed during diagnosis and treatment. Five of these patients later progressed to ECMO due to cardiac arrest during treatment with thrombolytic medication. Most of the patients were treated with heparin and thrombolytic medication, but if the medications were contraindicated, they were treated with either surgical thrombectomy or only with heparin awaiting spontaneous thrombolysis.RESULTS:: Of the 36 patients we intended to treat, 25 (69%) survived one month and 20 survived one year (56%). Of the 22 patients treated with ECMO, 11 survived one month (50%) and 10 survived one year (45%).DISCUSSION:: The treatment could have been more uniform. It seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE.CONCLUSION:: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving.

U2 - 10.1177/0267659119830014

DO - 10.1177/0267659119830014

M3 - Journal article

VL - 34

SP - 467

EP - 474

JO - Perfusion

JF - Perfusion

SN - 0267-6591

IS - 6

ER -