Management of Acute Massive Pulmonary Embolism During Pharmaco-mechanical Thrombectomy for Acute DVT: A Case Report

Abstract

This case report describes an incident of MPE during lower limb endovascular pharmaco-mechanical thrombectomy under sedation, which was immediately identified and promptly managed with cardiopulmonary resuscitation. After return of spontaneous circulation, ECMO was initiated, as her haemodynamics were unstable, and MPE was diagnosed based on transoesophageal echocardiography findings. During intensive care unit stay, she was successfully weaned off from ECMO and ventilatory support. However, the patient developed right-sided body weakness. Echocardiography showed a patent foramen ovale, and stroke due to paradoxical embolism was diagnosed. She was transferred to the ward in a stable condition and later discharged home. Abbreviations: MPE: Massive pulmonary embolism, ECMO: extracorporeal membrane oxygenation. Keywords: MPE: Massive pulmonary embolism, ECMO: extracorporeal membrane oxygenation, PFO: patent foramen ovale, PMT: pharmaco-mechanical thrombectomy, Sedation