Acute Pulmonary Thromboembolism Research Articles

Avoidable Overuse of Computed Tomography Pulmonary Angiography (CTPA) in Patients with Suspected Acute Pulmonary Thromboembolism (PTE): The Role of Clinical Prediction Rules and D-Dimer Assay

Avoidable Overuse of Computed Tomography Pulmonary Angiography (CTPA) in Patients with Suspected Acute Pulmonary Thromboembolism (PTE): The Role of Clinical Prediction Rules and D-Dimer Assay

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity.

This study examined the effects of sildenafil on acute pulmonary embolism (APE) using a rat model. Sprague-Dawley rats were randomly divided into the sham, pulmonary thromboembolism (PTE), and sildenafil groups. The sham and PTE groups received normal saline once daily via gavage for 14 consecutive days, whereas the sildenafil group received sildenafil (0.5 mg/kg/day) once daily via gavage for 14 consecutive days. Autologous emboli were prepared from blood samples collected from the left femoral artery of rats in each group on day 13, and autologous emboli were injected into the jugular vein cannula of rats in the PTE and sildenafil groups on day 14. Sham-treated rats received the same volume of saline. Right systolic ventricular pressure (RVSP) and mean pulmonary arterial pressure (MPAP) were used to assess pulmonary embolism, and western blotting and enzyme-linked immunosorbent assay were used to detect relevant markers. The Rho kinase signaling pathway was significantly activated in rats with APE, and sildenafil significantly inhibited this activation. Sildenafil protected against APE through inhibiting Rho kinase activity, thereby reducing pulmonary vasoconstriction and decreasing elevated pulmonary arterial pressure. These findings might provide new ideas for the clinical treatment of acute pulmonary thromboembolism.

Imaging of Patients Suspected of Having Pulmonary Thrombo-Embolic Disease; The Value of Chest X-Ray Combined with Perfusion Scan

Objective: To determine the value of a recent chest x-ray (done within 24 hours of the perfusion scan) combined with perfusion in diagnosing acute pulmonary thromboembolism in clinical settings. Methodology: Retrospective analysis of 155 consecutive patients clinically suspected with pulmonary thromboembolism between January 2017 and January 2019, who underwent a lung scintigraphy. Results: Most of the study participants (75.5%) were black Africans. The overall population studied had a mean age of 50.09 years (SD 16.78). A recent chest x-ray was found in 40.1% of the projected sample size of 386 patients. The sensitivity and specificity of the PISAPED 1 reader were 96% and 97%, respectively, with a NPV and PPV of 99% and 89%. The sensitivity and specificity of the PISAPED 2 reader were both 96%, with a NPV and PPV of 86%and 99%, respectively. The PIOPED II and the PISAPED 1 had an agreement of 88.39% (Kappa value of 0.7348) while the PIOPED II and the PISAPED 2 had an agreement of 88.39% (Kappa value of 0.7444). Conclusion: Chest x-ray in conjunction with perfusion scintigraphy is accurate and can be used where ventilation/perfusion scintigraphy cannot be done in the diagnosis of pulmonary embolism.

Target sign in COVID-19, radiological interpretation and diagnostic contribution of digital thoracic tomosynthesis

IntroductionOur objectives are: To describe the radiological semiology, clinical-analytical features and prognosis related to the target sign (TS) in COVID-19. To determine whether digital thoracic tomosynthesis (DTT) improves the diagnostic ability of radiography. Material and methodsRetrospective, descriptive, single-centre, case series study, accepted by our ethical committee. Radiological, clinical, analytical and follow-up characteristics of patients with COVID-19 and TS on radiography and DTT between November 2020 and January 2021 were analysed. ResultsEleven TS were collected in 7 patients, median age 35 years, 57% male. All TS presented with a central nodule and a peripheral ring, and in at least 82%, the lung in between was of normal density. All TS were located in peripheral, basal regions and 91% in posterior regions. TS were multiple in 43%. Contiguous TS shared the peripheral ring. Other findings related to pneumonia were associated in 86% of patients. DTT detected 82% more TS than radiography. Only one patient underwent a CT angiography of the pulmonary arteries, positive for acute pulmonary thromboembolism. Seventy-one per cent presented with pleuritic pain. No distinctive laboratory findings or prognostic worsening were detected. ConclusionsTS in COVID-19 predominates in peripheral and declining regions and can be multiple. Pulmonary thromboembolism was detected in one case. It occurs in young people, frequently with pleuritic pain and does not worsen the prognosis. DTT detects more than 80 % of TS than radiography.

Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report

BackgroundClinical characteristics of patients with pulmonary thromboembolism have been described in previous studies. Although very old patients with pulmonary thromboembolism are a special group based on comorbidities and age, they do not receive special attention.ObjectiveThis study aims to explore the clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism in a relatively large population.Design and participantsThe study included a total of 7438 patients from a national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES). Consecutive patients with acute pulmonary thromboembolism were enrolled and were divided into three groups. Comparisons were performed between these three groups in terms of clinical characteristics, comorbidities and in-hospital prognosis. Mortality predictors were analyzed in very old patients with pulmonary embolism.Key resultsIn 7,438 patients with acute pulmonary thromboembolism, 609 patients aged equal to or greater than 80 years (male 354 (58.1%)). There were 2743 patients aged between 65 and 79 years (male 1313 (48%)) and 4095 patients aged younger than 65 years (male 2272 (55.5%)). Patients with advanced age had significantly more comorbidities and worse condition, however, some predisposing factors were more obvious in younger patients with pulmonary thromboembolism. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2, malignancy, anticoagulation as first therapy were mortality predictors for all-cause death in very old patients with pulmonary thromboembolism. The analysis found that younger patients were more likely to have chest pain, hemoptysis (the difference was statistically significant) and dyspnea triad.ConclusionIn very old population diagnosed with pulmonary thromboembolism, worse laboratory results, atypical symptoms and physical signs were common. Mortality was very high and comorbid conditions were their features compared to younger patients. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2 and malignancy were positive mortality predictors for all-cause death in very old patients with pulmonary thromboembolism while anticoagulation as first therapy was negative mortality predictors.

Risperidone Associated With Acute Pulmonary Thromboembolism: A Case Report

Antipsychotic drugs (APs) are widely used drugs for schizophrenia. For decades, these agents are frequently associated with some side-effects, including increased the risk of Venous Thromboembolism (VTE). A case of a man (53 years old) with schizophrenia was reported in this study. The man with no identified risk factor for thromboembolism, and developed Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) after treatment with risperidone 2 years. The current case indicates that use of risperidone for long time can be associated with the risk of PTE and DVT. Risperidone is a Second-Generation Antipsychotic medication (SGA), as a mixed serotonin 5HT2 and dopamine D2 receptor antagonist possibly implicated in this adverse event. As suggested by this observation, VTE and PTE risk not just appears to new users, so they should be vigilant monitored to ensure early detection and prompt treatment of VET and PTE during medication.

Validation of a Recently Developed Fluoroscopic Video Analysis Workstation (Radwisp™) for the Reliable Diagnosis of Acute Pulmonary Thromboembolism.

Objective Radwisp™ is a fluoroscopic video analysis workstation recently developed to evaluate pulmonary circulation, thereby obviating the need for contrast medium or breath-holding. This study validated Radwisp as a diagnostic tool for acute pulmonary embolism (APE) and evaluated its potential utility in patients with symptoms of suspected APE. Methods The study included 10 patients (mean age, 69±16 years old) who were admitted to our hospital for suspected APE based on symptoms and physical examination findings between January 2020 and April 2021. Contrast-enhanced computed tomography (CT) and cineradiography, based on standard radiographs for the creation of a Radwisp image, were performed on the same day. Of the 10 cases of suspected APE, 7 were definitively diagnosed by CT with APE, and 3 were definitively diagnosed as not having APE. Fifty physicians (25 cardiologists and 25 residents) were blinded to patient information and CT images and asked to diagnose the presence of APE based solely on the Radwisp images. Results A total of 250 diagnoses were made by cardiologists and 250 by residents. Among the cardiologists, the sensitivity and specificity of the Radwisp-based analysis were 91% and 48%, respectively, and the positive and negative predictive values were 80% and 69%, respectively. Among the residents, the sensitivity and specificity were 88% and 35%, respectively, and the positive and negative predictive values were 76% and 55%, respectively. Conclusion This study showed an initial validation of Radwisp for diagnosing APE, revealing a high sensitivity but not yet achieving a high specificity. Further studies with a larger number of cases are needed to thoroughly evaluate the diagnostic performance.

Evaluation of right ventricle functions in acute pulmonary thromboembolism using tissue doppler imaging

Aims: Right ventricular (RV) systolic and diastolic functions are impaired in a significant proportion of patients with acute pulmonary thromboembolism (PTE). In these cases, knowledge of RV function is of great importance both in the diagnosis and in the choice of treatment. Our aim was to evaluate RV systolic and diastolic functions by standard pulse Doppler and tissue Doppler imaging (TDI) in normotensive patients with PTE without hemodynamic disturbances. Methods: A total of 48 subjects, including 28 acute PTE patients (14 M, 14 F) with a mean age of 41 ± 13 years and 20 healthy subjects (10 M, 10 F) with a mean age of 40 ± 9 years, were included in our study. At the level of the tricuspid and mitral valve cusps, pulse Doppler echocardiography evaluated diastolic filling parameters. With the TDI technique, the diastolic function of the RV lateral wall and septum were analyzed in segments in the apical four-cavity image. Diastolic early and late velocities (e', a'), e'/a' ratio, e'dt, isovolumetric relaxation time (IVRT), systolic velocity (s'), and systolic duration (s' duration) were evaluated by TDI. Results: Among the RV standard Doppler parameters, a significant decrease in E velocity and E/A ratio and a significant increase in A velocity were observed compared to the control group (p=0.042; p=0.002; p=0.001, respectively). A non-significant prolongation in E’dt was detected. RV ejection fraction was significantly lower in PTE patients compared to the control group (51.1% vs. 69.7%) (p=0.001). TDI was used to look at the RV systolic function, and it was found that all segments had higher systolic (Sa-m) velocities than the control group. However, systolic velocities in patients with DHB in the RV were found to be lower in the annular regions and RV-free wall. Increased s' velocities were observed in annular regions and RV-free walls. However, no statistical significance was found in s' velocity values. Conclusion: RV systolic and diastolic functions may be impaired in normotensive patients with PTE without hemodynamic disturbances.

Detection of pulmonary thrombembolism and postmortem clotting on postmortem magnetic resonance imaging

The purpose of this study was to develop a feasible imaging protocol superior to postmortem computed tomography (PMCT) and to establish diagnostic parameters for diagnosing pulmonary thromboembolism (PE) on postmortem magnetic resonance imaging (PMMR).The study collective of 113 subjects was prospectively investigated by PMMR for the presence of PE and / or postmortem clotting (cruor). PE was detected in 20 cases; the remaining 93 cases were investigated for the morphology of cruor. Age grading was performed by PMMR, autopsy and histology. The postmortem sedimentation effect was used for the applied imaging protocol on PMMR (supine and prone position). Visual distension of the pulmonary arteries in PE was seen in all cases, but not in the controls. Re-positioning of the corpse from supine in prone position proved to be beneficial in 90 %. Postmortem motion artifacts are firstly described in 20.4 %. Hyperacute PE (grade 1) presented with a homogenous and hypointense signal on T2w images, acute PE (grade 2) with slightly heterogeneous, but still homogenous hypointense signal, subacute PE (grade 3) was with heterogeneous and slightly hyperintense signal and chronic PE (grade 4) with predominately homogenous with scarce portions of heterogeneous but hyperintense signal. PMMR allowed for the detection of PE and for in situ depiction of combined age grading.

Troponin I and D-dimer levels as triaging biomarkers to distinguish acute pulmonary thromboembolism from myocardial infarction

Background: Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data.Methods: We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset.Results: The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%.Conclusions: Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI.

Alteraciones pulmonares persistentes tras 18 meses de neumonía por SARS-CoV-2

ObjectiveTo describe persistent pulmonary abnormalities detected on HRCT after 18months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function. Patients and methodsA prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations). ResultsOf the 31 patients included: 20 (65%) were men; mean age was 67years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Extension of total pulmonary abnormalities, ground-glass opacities and reticulation was 19%, 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC <80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO <80% in 22 patients (70%). We observed a statistically significant relationship between total extension of abnormalities on HRCT and FVC (P<.05), and a trend towards statistical significance with DLCO (P=.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P<.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P<.05). ConclusionPersistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

The correlation between the CT angiographic pulmonary artery obstructive index and clinical data in patients with acute pulmonary thromboembolism.

The potentially fatal consequences of pulmonary embolism emphasize the need for more effective diagnostic methods. The Qanadli obstruction index has been described as a convenient tool for risk stratification to determine and quantify the degree of obstruction. This study aimed to assess the correlations between the Qanadli index with clinical and paraclinical findings (D-dimer, troponin, and echocardiographic findings) in patients with pulmonary embolism. A total of 102 patients with pulmonary embolism underwent echocardiography and CT pulmonary angiography at a single tertiary referral center between 2019 and 2020. The clinical and paraclinical findings, pulmonary arterial obstruction index, atrial measurements, right and left ventricle size and function, tricuspid annular plane systolic excursion, pulmonary artery pressure, and pulmonary hypertension (PH) were analyzed. Vital signs were recorded and assessed. The Qanadli index score was measured, and graded risk stratification was measured based on the quantified index score. The total mean Qanadli index was 28.75 ± 23.75, and there was no significant relationship between the Qanadli index and gender. Patients' most common clinical findings were exertional dyspnea (84.3%; n = 86) and chest pain (71.7%; n = 73). There were significant correlations between the Qanadli index and pulse rate (PR), troponin, D-dimer levels, and PH. Four patients died during the study, including one from a cardiac condition and three with non-cardiac conditions. It is possible to determine the severity, prognosis, and appropriate treatment by the Qanadli index based on strong correlations with PR, troponin, D-dimer levels, and PH.

Neurological outcomes and quality of life in post-cardiac arrest patients with return of spontaneous circulation supported by ECMO: A retrospective case series.

Post-cardiac arrest brain injury constitutes a significant contributor to morbidity and mortality, leading to cognitive impairment and subsequent disability. Individuals within this patient cohort grapple with uncertainty regarding the potential advantages of extracorporeal life support (ECMO) cannulation. This study elucidates the neurological outcomes and quality of life of post-cardiac arrest patients who attained spontaneous circulation and underwent ECMO cannulation. This is a retrospective case study within a local context, the research involved 32 patients who received ECMO support following an intrahospital cardiac arrest with return of spontaneous circulation (ROSC). An additional 32 patients experienced cardiac arrest with ROSC before undergoing cannulation. The average age was 41 years, with the primary causes of cardiac arrest identified as acute coronary syndrome (46.8%), pulmonary thromboembolism (21.88%), and hypoxemia (18.7%). The most prevalent arrest rhythm was asystole (37.5%), followed by ventricular fibrillation (34.4%). The mean SOFA score was 7 points (IQR 6.5-9), APACHE II score was 12 (IQR 9-16), RESP score was -1 (IQR -1 to -4) in cases of respiratory ECMO, and SAVE score was -3 (IQR -5 to 2) in cases of cardiac ECMO. Overall survival was 71%, and at 6 months, the Barthel score was 75 points, modified Rankin score was 2, cerebral performance categories score was 1, and the SF-12 had an average score of 30. Notably, there were no significant associations between the time, cause, or rhythm of cardiac arrest and neurological outcomes. Importantly, cardiac arrest is not a contraindication for ECMO cannulation. A meticulous assessment of candidates who have achieved spontaneous circulation after cardiac arrest, considering the absence of early signs of poor neurological prognosis, is crucial in patient selection. Larger prospective studies are warranted to validate and extend these findings.

The relationship between echocardiographic parameters and albumin bilirubin score in patients with acute pulmonary thromboembolism.

The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. We investigated whether the ALBI score, a parameter indicating liver stiffness, congestion and fibrosis, has any relationship with echocardiographic parameters in patients with acute pulmonary thromboembolism (PTE). A total of 140 patients diagnosed with acute PTE were retrospectively analyzed. These patients were divided into three groups according to the hemodynamic severity of acute PTE: Group I [Low risk]; Group II [Submassive or intermediate-risk]; and Group III [Massive or high-risk]. Biochemical data obtained from venous blood samples taken at admission were analyzed. In addition, data were also analyzed from transthoracic echocardiography and pulmonary computed tomographic angiography performed at admission. ALBI, Bova, and PESI scores were calculated. ALBI scores (-3.32 ± 0.21 vs -2.86 ± 0.15 vs -2.46 ± 0.2, p < .001) were statistically significantly higher in Group III than Groups I and II. There was a significant difference between the three groups in terms of echocardiographic parameters, and LVEF and TAPSE values tended to decrease from group I to group III. In multivariate linear regression analysis, sPAP, RV/RA diameter, and NT-pro-BNP were found to be significantly associated with the ALBI score. An ALBI score higher than -2.87 was associated with Bova stage II-III in patients with Group I and Group II PTE, with a sensitivity of 87% and a specificity of 62% (AUC = 0.804; 95% CI 0.713-0.895; p < .001). The ALBI score, which is a common, easy-to-use, and inexpensive method, may be beneficial to select intermediate and high-risk patients in patients with acute PTE. Additionally, it may have prognostic value in distinguishing low and intermediate-risk acute PTE patients.

ACUTE PULMONARY THROMBOEMBOLISM: ASSESSMENT OF SAFETY AND EFFICACY OF THROMBOLYTIC THERAPY WITH TENECTEPLASE IN LOW RESOURCE SETTING – NON RANDOMISED, SINGLE CENTRE,RETROSPECTIVE STUDY.

ACUTE PULMONARY THROMBOEMBOLISM: ASSESSMENT OF SAFETY AND EFFICACY OF THROMBOLYTIC THERAPY WITH TENECTEPLASE IN LOW RESOURCE SETTING – NON RANDOMISED, SINGLE CENTRE,RETROSPECTIVE STUDY.

An Unusual Case of Isolated Right Ventricular Thrombus and Bilateral Extensive Pulmonary Thromboembolism in an Adult with Nephrotic Syndrome Occurring Five Years after the Diagnosis: A Case Report

It is an established fact that nephrotic syndrome is associated with a heightened risk of thromboembolic complications including deep vein thrombosis (DVT), renal vein thrombosis (RVT) and pulmonary thromboembolism (PTE). Intra-cardiac thrombi are not uncommon but predominantly involve left atrium (LA), right atrium (RA) and left ventricle (LV). However, Isolated right ventricular (RV) thrombus in an adult with nephrotic syndrome was very rarely reported. Common causes of intra-cardiac thrombi include LV dysfunction, atrial fibrillation (AF), mitral stenosis (MS), nephrotic syndrome, cardiac prosthetic valves, indwelling central venous catheters, pacing leads, anti-phospholipid antibody syndrome, hyperhomocysteinemia, infection with COVID-19 virus, Behcet’s disease and congenital thrombophilia. Above conditions can cause intra-arterial, intravenous, as well as, intra-cardiac thrombi. Patients with nephrotic syndrome especially due to membranous glomerulonephritis can develop a hypercoagulable state in greater than 25% of adult patients. The risk of thrombosis was noted to be highest in the first three to six months after diagnosis. The exact incidence and prevalence of venous thromboembolism (VTE) are unknown in nephrotic syndrome. We are reporting a rare case of isolated RV thrombus presenting as acute PTE five years after initial diagnosis of nephrotic syndrome due to membranous glomerulonephritis which responded to thrombolytic therapy. There were only three case reports of isolated RV thrombus in an adult with nephrotic syndrome published so far.

Optional therapeutic management of intermediate-risk pulmonary embolism patients

Background: Few studies have evaluated the thrombolytic treatment in patients with intermediate-high risk pulmonary embolism, making this study more valuable. Material and methods: It was a prospective, non-randomized, open-label, single-center study. Eligible patients at the age of 18 or older with an acute pulmonary embolism (PE) confirmed by CT pulmonary angiography with onset until 14 day and signs of right ventricular (RV) overload on echocardiography took part in the study. Pulmonary Arterial CT Obstruction Index Rate (PACTOIR) was used to define the localization and the expansion zone of thromboembolism. This study included 18 patients with intermediate risk and acute submassive pulmonary thromboembolism. In thrombolysis (TT) group (n=9) were used 50 mg of tissue-plasminogen activator (t-PA) administered in infusion as 0.4 mg/h for 2 hours. In the standard anticoagulation group, unfractioned heparin (UFH) was administered as a bolus of 70 units/kg or a maximum of 5000 units, followed by continuous infusion at an initial rate of 16 units/kg or a maximum of 1000 units/h. Results: The mean age for TT group was 69 vs 63 for the UFH group. PACTOIR was 100% in 3 patients in the half-dose rt-PA group and in 2 patients in the UFH group. RV/LV diameter ratio decreased from baseline to 48 h post-procedure (1.55 vs. 1.13; mean difference, -0.42; p &lt; 0.0001). Mean pulmonary artery systolic pressure was 55 mm Hg in both groups (p &lt; 0.05), with 53 [43–60] in TT group vs. 41.5 [37–45] mmHg in UFH group, P&lt;0.05. Also, RV/ LV ratio and systolic PAP decreased significantly in both groups. Severe bleeding with a need in red blood cell transfusion was seen in 0.11% (1 patient) in the TT group vs 0 in UFH group. The hospitalization length of stay was significantly shorter in the TT group (3.8±1.8, p &lt; 0.05). The rate of secondary endpoints was significantly higher in the UFH group with a high rate of pulmonary hypertension (0 vs. 19%, p=0.003). Conclusions: Half-dose thrombolytic therapy in patients diagnosed with submassive pulmonary embolism significantly reduced death and hemodynamic decompensation in the first 7 days compared to anticoagulant therapy only. With all that being said, it can be concluded that patients with high-intermediate risk PE could benefit from reduced-dose TT.

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: one-year outcomes from a cardiac intensive care unit led shock team program

Abstract Background Mechanical circulatory support (MCS) with peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for severe cardiogenic shock (CS). Purpose To describe the initial experience with peripheral VA-ECMO within a cardiac intensivist team led program. Methods Retrospective analysis of a short-term MCS prospective registry, from 1 September 2021 to 1 December 2022. Clinical and device related variables were reviewed and reported. We assessed both patient outcomes as well as ECMO-related complications. Results A total of 21 patients were included in this analysis (50 ± 13 years-old, 80% male), ranging from SCAI-C (n = 8) to E (n = 5) and with a median predicted mortality by SAVE score of -4 points [IQ -6 - 0] (corresponding to 30% in-hospital survival). All cannulations were done percutaneously, mostly by trained cardiac intensivists and while at the CICU (n = 12). A femoro-femoral configuration was used for all patients. One patient was cannulated at the referring hospital and retrieved to our unit for further care. Three patients were cannulated during intra-hospital cardiac arrest and one patient was cannulated while breathing spontaneously (awake-ECMO). Mean venous and arterial cannula sizes were 22 ± 1.9 Fr and 17 ± 1.6 Fr, respectively. A 7 French (Fr) arterial limb reperfusion cannula was used in 85% of cases. The most frequent etiology was acute decompensation of chronic heart failure (n = 7), followed by acute myocardial infarction related CS (n = 5), fulminant myocarditis (n = 2) and massive pulmonary thromboembolism (n = 2). A left ventricle venting device was used in 70% of patients [intra-aortic balloon pump (n = 10); percutaneous microaxial pump ( n = 2)] and upgrade to a veno-arterio-venous configuration was necessary in one patient due to differential hypoxemia. Mean ECMO-run duration was 8.4 ± 4.8 days while mean CICU length of stay was 22 ± 17.9 In-hospital mortality was 40%. In survivors, decannulation was surgical in all but one patient. The most frequent strategy was bridge to recovery (n = 14). One patient was bridged directly to heart transplant, one to a temporary centrifugal left ventricular assist device (LVAD) and one to a durable magnetically levitated LVAD. Complications were common and included bleeding from cannula insertion sites (n = 19), renal replacement therapy requirement (n= 10), Harlequin syndrome (n = 2), cardiac tamponade (n = 2), intestinal ischemia (n = 3) and limb ischemia (n = 2). Conclusion VA-ECMO performed by cardiac intensivists is a feasible MCS strategy for severe cardiogenic shock patients in whom mortality, while high, was similar to large international published series. Further experience will allow for improvement in patient selection and minimization of device related complications.ECMO VA 1 year single-center experience

A Case Report of Patient Suffering from Cough and Dyspnea after Lung Transplantation Treated with Complex Korean Medicine

We report the case of a lung transplantation patient whose cough and dyspnea symptoms improved after receiving complex Korean medicine treatment. Lung transplantation provides a solution to many end-stage patients with lung disease who are refractory to conventional treatment, but the five-year survival rate of lung transplantation remains around 50%, and even surviving patients suffer from side effects, including infection, respiratory difficulty, and gastrointestinal problems. A 66-year-old woman with rheumatoid arthritis-interstitial lung disease was advised to undergo lung transplantation surgery when she suffered from dyspnea and failing respiratory symptoms after being diagnosed with COVID-19 and contracting pneumonia. Approximately five months after receiving a bilateral lung transplantation operation, she experienced acute pulmonary thromboembolism, and even after receiving anticoagulation therapy, she still struggled with cough and respiratory difficulty. After she received complex Korean medicine treatments, including herbal medicine, cupping therapy, and electrical moxibustion, we observed a decrease in inflammation, alleviation of symptoms such as cough and dyspnea, and improvement of pulmonary function and exercise capacity.