Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 4098-4104
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4098
Cardiac arrest secondary to pulmonary embolism treated with extracorporeal cardiopulmonary resuscitation: Six case reports
Min-Shan Qiu, Yong-Jin Deng, Xue Yang, Han-Quan Shao
Min-Shan Qiu, Yong-Jin Deng, Xue Yang, Han-Quan Shao, Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan 523058, Guangdong Province, China
Author contributions: Shao HQ and Qiu MS designed the study; Deng YJ and Yang X collected the data; Shao HQ and Qiu MS wrote the manuscript; All authors have read and approved the final manuscript.
Supported by Dongguan Science and Technology of Social Development Program, No. 202050715001213.
Informed consent statement: This study was approved by the Clinical Ethics Committee of Dongguan People’s Hospital, No. KYKT2021-028. Informed written consent was obtained from the patients or their family members for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Han-Quan Shao, Doctor, Associate Chief Physician, Department of Critical Care Medicine, Dongguan People’s Hospital, No. 3 Wandao Avenue, Wanjiang District, Dongguan 523058, Guangdong Province, China. hqshao0559@163.com
Received: March 10, 2023
Peer-review started: March 10, 2023
First decision: April 26, 2023
Revised: April 30, 2023
Accepted: May 22, 2023
Article in press: May 22, 2023
Published online: June 16, 2023
Processing time: 93 Days and 16.1 Hours
Abstract
BACKGROUND

Massive pulmonary embolism (PE) results in extremely high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide circulatory and oxygenation support and rescue patients with massive PE. However, there are relatively few studies of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest (CA) secondary to PE. The aim of the present study is to investigate the clinical use of ECPR in conjunction with heparin anticoagulation in patients with CA secondary to PE.

CASE SUMMARY

We report the cases of six patients with CA secondary to PE treated with ECPR in the intensive care unit of our hospital between June 2020 and June 2022. All six patients experienced witnessed CA whilst in hospital. They had acute onset of severe respiratory distress, hypoxia, and shock rapidly followed by CA and were immediately given cardiopulmonary resuscitation and adjunctive VA-ECMO therapy. During hospitalization, pulmonary artery computed tomography angiography was performed to confirm the diagnosis of PE. Through anticoagulation management, mechanical ventilation, fluid management, and antibiotic treatment, five patients were successfully weaned from ECMO (83.33%), four patients survived for 30 d after discharge (66.67%), and two patients had good neurological outcomes (33.33%).

CONCLUSION

For patients with CA secondary to massive PE, ECPR in conjunction with heparin anticoagulation may improve outcomes.

Keywords: Extracorporeal cardiopulmonary resuscitation; Cardiac arrest; Pulmonary embolism; Outcomes; Shock; Case report

Core Tip: Massive pulmonary embolism (PE) remains the leading clinical cause of death. Unfortunately, relatively few new technologies are available to reduce the morbidity and mortality of massive PE. Anticoagulation therapy is still the gold standard treatment for PE. In this study, we report the clinical details of six patients with cardiac arrest secondary to massive PE treated with extracorporeal cardiopulmonary resuscitation (ECPR) in conjunction with heparin anticoagulation. Our findings suggest that the use of ECPR is feasible in this cohort of patients and may improve resuscitation success rate and neurologically intact survival.