Abstract
HIGH-RISK OR MASSIVE pulmonary embolism (PE) is defined as acute PE with clinical presentations of cardiac arrest, acute respiratory failure, obstructive shock requiring ionotropic therapy, or sustained hypotension for >15 minutes. 1 Tapson VF Weinberg AS. Overview of management of intermediate- and high-risk pulmonary embolism. Crit Care Clin. 2020; 36: 449-463 Abstract Full Text Full Text PDF Scopus (4) Google Scholar Treatments for massive PE include the initiation of a PE response team (PERT), anticoagulation, systemic thrombolysis, and catheter-directed or surgical embolectomy. 1 Tapson VF Weinberg AS. Overview of management of intermediate- and high-risk pulmonary embolism. Crit Care Clin. 2020; 36: 449-463 Abstract Full Text Full Text PDF Scopus (4) Google Scholar Although there are mixed data supporting its superiority over other therapies, studies have shown that extracorporeal membrane oxygenation (ECMO) is another salvage therapy that can be used to support a subset of patients with respiratory and circulatory collapse despite therapeutic treatments. 2 Al-Bawardy R Rosenfield K Borges J et al. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: A case series and review of the literature. Perfusion. 2019; 34: 22-28 Crossref PubMed Scopus (51) Google Scholar , 3 Baldetti L Beneduce A Cianfanelli L et al. Use of extracorporeal membrane oxygenation in high-risk acute pulmonary embolism: A systematic review and meta-analysis. Artif Organs. 2021; 45: 569-576 Crossref PubMed Scopus (5) Google Scholar , 4 Guliani S Das Gupta J Osofsky R et al. Venoarterial extracorporeal membrane oxygenation is an effeive management strategy for massive pulmonary embolism patients. J Vasc Surg Venous Lymphat Disord. 2021; 9: 307-314 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 5 O'Malley TJ Choi JH Maynes EJ et al. Outcomes of extracorporeal life support for the treatment of acute massive pulmonary embolism: A systematic review. Resuscitation. 2020; 146: 132-137 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 6 Yusuff HO Zochios V Vuylsteke A. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: A systematic review. Perfusion. 2015; 30: 611-616 Crossref PubMed Scopus (93) Google Scholar , 7 George B Parazino M Omar HR et al. A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support. Resuscitation. 2018; 122: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar , 8 Karami M Mandigers L Miranda DDR et al. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care. 2021; 64: 245-254 Crossref PubMed Scopus (10) Google Scholar Heparin-induced thrombocytopenia with thrombosis (HITT) is an immune-mediated thrombocytopenia in which autoantibodies to platelet factor 4-heparin complexes result in platelet activation. This activation of platelets can lead to thrombosis and consumptive thrombocytopenia. 9 Datta P Zhang F Dordick JS et al. Platelet factor 4 polyanion immune complexes: Heparin induced thrombocytopenia and vaccine-induced immune thrombotic thrombocytopenia. Thromb J. 2021; 19: 66 Crossref Scopus (4) Google Scholar HITT can cause a variety of thrombotic events, including PE, and its management includes nonheparin anticoagulation. Pulmonary Embolism: HITT the Nail on the HeadJournal of Cardiothoracic and Vascular AnesthesiaPreviewTHE AUTHORS READ WITH great interest the recent article by Kawaji et al. in the Journal of Cardiothoracic and Vascular Anesthesia.1 In this work, the authors described the case of a patient with known malignancy treated surgically, who developed a massive pulmonary embolism postoperatively in the setting of heparin-induced thrombocytopenia (HIT). The patient underwent venoarterial extracorporeal membrane oxygenation (VA ECMO) support with bivalirudin anticoagulation after a lack of improvement with anticoagulation and multiple thrombolysis attempts. Full-Text PDF
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