Percutaneous cardiopulmonary support in pulmonary embolism with cardiac arrest

Abstract

Objective: To assess the role of percutaneous cardiopulmonary support (PCPS) for the resuscitation of patients with massive pulmonary embolism (PE) with circulatory collapse. We also compared outcomes for PCPS between patients with massive PE with circulatory collapse and patients with AMI with cardiogenic shock.

Background: The effectiveness of PCPS for acute myocardial infarction (AMI) complicated with cardiogenic shock has been reported, but there are few reports on the use of PCPS for massive PE with circulatory collapse.

Method: We studied 12 consecutive patients with massive PE and 16 patients with AMI, who required PCPS for resuscitation either during cardiopulmonary resuscitation (CPR) or after successful CPR.

Results: Twelve patients with PE and 16 patients with AMI were identified. There were no differences in age, the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) score at admission, rate of cardiac arrest on arrival, and time from first circulatory collapse to PCPS between the two groups. However, the proportion of men with PE (33%) was smaller than those with AMI (87%, p<0.05). The duration of PCPS was shorter in PE (38 h) compared with AMI (83 h, p=0.051) patients. The proportion of patients successfully weaned from PCPS (100% vs. 37.5%, p<0.01), survival rate at discharge (83.3% vs. 12.5%, p<0.001) and good neurological outcome (58.3% vs. 6.3%, p=0.004) was significantly higher for PE compared to AMI patients.

Conclusion: In our small case series, percutaneous cardiopulmonary support (PCPS) had a life saving role in patients with massive PE and cardiac arrest. PCPS was also more effective in patients with massive PE with cardiac arrest than in patients with AMI and cardiac arrest.