Extracorporeal CPR for massive pulmonary embolism in a "hybrid 2136 emergency department"

Kazuki Miyazaki; Mayu Hikone; Yusuke Kuwahara; Takuto Ishida; Kazuhiro Sugiyama; Yuichi Hamabe

doi:10.1016/j.ajem.2019.01.039

Extracorporeal CPR for massive pulmonary embolism in a "hybrid 2136 emergency department"

Am J Emerg Med. 2019 Dec;37(12):2132-2135. doi: 10.1016/j.ajem.2019.01.039. Epub 2019 Jan 22.

Authors

Kazuki Miyazaki¹, Mayu Hikone², Yusuke Kuwahara², Takuto Ishida², Kazuhiro Sugiyama², Yuichi Hamabe²

Affiliations

¹ Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: miyazaki2nd@gmail.com.
² Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.

PMID: 30691862
DOI: 10.1016/j.ajem.2019.01.039

Abstract

Aim: Patients with massive pulmonary embolism (PE) have poor outcomes and their management remains challenging. An interventional radiology (IVR)-computed tomography (CT) system available in our emergency room (ER) allows immediate access to CT and extracorporeal membrane oxygenation (ECMO) with safe cannulation under fluoroscopy. We aimed to determine if initial treatment in this "hybrid ER" is helpful in patients with PE requiring extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: The records of patients transferred to our hybrid ER between September 2014 and December 2017 who required ECPR for PE were reviewed.

Results: Nine consecutive patients (median age 50 [range 30-76] years) with PE requiring ECPR were identified in our hybrid ER. Five (55.6%) had at least one risk factor for PE. Six (66.7%) experienced an out-of-hospital cardiac arrest and 3 (33.3%) had a cardiac arrest in the hybrid ER. Right ventricular overload was detected on electrocardiography and bedside transthoracic echocardiography in all cases. The median pH, lactate, PaCO₂, and HCO₃ values on arterial blood gas analysis in the hybrid ER were 7.01 (6.68-7.26), 14 (8-22) mmol l^-1, 44.7 (23.8-60.5) mmHg, and 10.4 (6.7-14.1), respectively. Four patients (44.4%) received monteplase for thrombolysis. No patient underwent surgical embolectomy. The median duration of ECMO was 69 (38-126) h. There were two ECMO-related bleeding complications. Eight patients (88.9%) survived and one died of post-resuscitation encephalopathy after weaning from ECMO.

Conclusion: A hybrid ER may be useful for initial management of massive PE requiring ECPR and may help to improve outcomes.

Keywords: Extracorporeal cardiopulmonary resuscitation; Hybrid emergency room; Pulmonary embolism.

MeSH terms

Adult
Aged
Cardiopulmonary Resuscitation / methods*
Emergency Service, Hospital / organization & administration
Extracorporeal Membrane Oxygenation / methods*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / diagnostic imaging
Out-of-Hospital Cardiac Arrest / etiology
Out-of-Hospital Cardiac Arrest / therapy*
Pulmonary Embolism / complications
Pulmonary Embolism / diagnostic imaging
Pulmonary Embolism / therapy*
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome