Wu Hongyu, Liu Sibo, Yang Rongli, Li Hong
Department of Critical Care Medicine, Dalian Municipal Central Hospital Affiliated to Dalian University of Technology, Dalian, China.
The Seventh Obstetrics Department, Dalian Women and Children's Medical Center Group, Dalian, China.
AME Case Rep. 2024 Jul 8;8:79. doi: 10.21037/acr-23-128. eCollection 2024.
With regard to the treatment of massive pulmonary embolism (MPE) with circulatory and respiratory collapse and thrombolytic contraindications, current guidelines and researches usually give the priority to veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, the objective of this clinical case report is to highlight the effective use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in a 35-year-old pregnant woman with MPE complicated by hemorrhage, persistent hypoxia and multiple cardiac arrests.
A 35-year-old pregnant woman with gestational mellitus suddenly presented with complaints of nausea, vomiting and dyspnea after going to the toilet, combined with increasing heart rate (HR) of 150 bpm, decreasing pulse oxygen saturation (SpO) of 94%, larger right heart and the growing D-dimer at 11.2 µg/mL, who was considered as the pulmonary embolism. Unpredictable cardiac arrest occurred repeatedly before and after the cesarean section. Although cardiopulmonary resuscitation (CPR) was started timely and successfully, the maintenance of blood pressure still depended on high-dose pressor drugs, even terribly, the oxygenation was unstable under the assistance of mechanical ventilation with pure oxygen. Thus, V-V ECMO supporting was commenced following by gradual recovering in haemodynamics and respiratory function. And the diagnosis of MPE was ascertained again through computed tomographic pulmonary angiography (CTPA) and pulmonary angiography. Directing at the pathogeny, thrombolysis infusion catheters and anticoagulant therapy were initiated after bilateral uterine artery embolism for postpartum haemorrhage, later the patient discharged from hospital after recovery and had a good prognosis.
V-V ECMO could be effective for some patients with MPE who suffer from successful CPR after cardiac arrest while still combined with severe hypotension and refractory hypoxemia.
对于伴有循环和呼吸衰竭且有溶栓禁忌证的大面积肺栓塞（MPE）的治疗，当前指南和研究通常优先选择静脉-动脉体外膜肺氧合（V-A ECMO）。然而，本临床病例报告的目的是强调静脉-静脉体外膜肺氧合（V-V ECMO）在一名35岁并发出血、持续性低氧血症和多次心脏骤停的MPE孕妇中的有效应用。
一名患有妊娠期糖尿病的35岁孕妇，如厕后突然出现恶心、呕吐和呼吸困难，心率（HR）增至150次/分钟，脉搏血氧饱和度（SpO）降至94%，右心增大，D-二聚体升至11.2µg/mL，被诊断为肺栓塞。剖宫产手术前后反复发生不可预测的心脏骤停。尽管及时成功地开始了心肺复苏（CPR），但血压维持仍依赖大剂量升压药物，甚至在纯氧机械通气辅助下氧合仍不稳定。因此，开始进行V-V ECMO支持，随后血流动力学和呼吸功能逐渐恢复。通过计算机断层扫描肺动脉造影（CTPA）和肺动脉造影再次确诊为MPE。针对病因，在双侧子宫动脉栓塞治疗产后出血后开始溶栓灌注导管和抗凝治疗，患者康复出院，预后良好。
对于一些心脏骤停后成功进行CPR但仍合并严重低血压和难治性低氧血症的MPE患者，V-V ECMO可能有效。
