Departamento de Anestesiologia, Hospital Universitário Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal.
Departamento de Terapia Intensiva, Hospital Universitário Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal.
Rev Bras Ter Intensiva. 2022 Oct-Dec;34(4):524-528. doi: 10.5935/0103-507X.20220342-pt. Epub 2023 Mar 3.
Acute massive pulmonary embolism is the most serious presentation of venous thromboembolism that can ultimately cause obstructive shock, leading to cardiac arrest and death. In this case report, the authors present a case of a 49-year-old female who successfully recovered from a massive pulmonary embolism with the combined use of venoarterial extracorporeal membrane oxygenation and pulmonary aspiration thrombectomy, with no complications from these procedures. Although evidence of benefit from mechanical support has not been established for patients with massive pulmonary embolism, the implementation of extracorporeal cardiocirculatory support during resuscitation may allow improvement of systemic organ perfusion and better chance of survival. Recent guidelines from the European Society of Cardiology state that venoarterial extracorporeal membrane oxygenation in combination with catheter-directed treatment may be considered for patients presenting with massive pulmonary embolism and refractory cardiac arrest. The use of extracorporeal membrane oxygenation as a stand-alone technique with anticoagulation remains controversial, and additional therapies, such as surgical or percutaneous embolectomy, must be considered. Since this intervention is not supported by high-quality studies, we believe it is important to report real-world successful cases. With this case report, we illustrate the benefit derived from resuscitation assisted by extracorporeal mechanical support and early aspiration thrombectomy in patients with massive pulmonary embolism. Additionally, it emphasizes the synergy that derives from integrated multidisciplinary systems for providing complex interventions, of which extracorporeal membrane oxygenation and Interventional Cardiology are clear examples.
急性大面积肺栓塞是静脉血栓栓塞症最严重的表现,最终可导致阻塞性休克,进而导致心脏骤停和死亡。在本病例报告中,作者报告了 1 例 49 岁女性患者,该患者成功地接受了静脉动脉体外膜肺氧合联合肺动脉血栓抽吸治疗,这些治疗没有引起任何并发症。尽管机械支持对大面积肺栓塞患者的益处尚未得到证实,但在复苏过程中实施体外心肺循环支持可能会改善全身器官灌注并提高生存机会。欧洲心脏病学会最近的指南指出,对于出现大面积肺栓塞和难治性心脏骤停的患者,可考虑联合导管直接治疗的静脉动脉体外膜肺氧合。单独使用体外膜氧合作为抗凝治疗的一种手段仍然存在争议,必须考虑其他治疗方法,如手术或经皮取栓术。由于这种干预措施没有高质量的研究支持,我们认为报告真实世界中的成功案例非常重要。通过本病例报告,我们说明了在大面积肺栓塞患者中,体外机械支持和早期血栓抽吸复苏辅助治疗的益处。此外,它强调了综合多学科系统提供复杂干预措施的协同作用,体外膜肺氧合和介入心脏病学就是明显的例子。
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