[A case report of modified venous-arterial extracorporeal membrane oxygenation combined with interventional therapy for high-risk pulmonary embolism using a Crescent double-lumen catheter].
Source: PubMed, NCBI / U.S. National Library of Medicine
High-risk pulmonary embolism is characterized by acute onset, rapid progression, and high mortality, underscoring the critical need for establishing an efficient multidisciplinary collaborative rescue system. This article reports the successful management of a 61-year-old male patient with high-risk pulmonary embolism following multiple injuries from a fall and subsequent deep vein thrombosis. In August 2024, the patient was admitted to The Fourth Affiliated Hospital of Guangxi Medical University with the chief complaint of "5 days of general multiple traumas after a fall and 8 hours of dyspnea". Five days prior to admission, the patient was hospitalized at The First People's Hospital of Hechi City for multiple injuries caused by a fall, during which an inferior vena cava filter was placed due to lower extremity deep vein thrombosis. The day after filter implantation, the patient developed dyspnea. Despite mechanical ventilation and vasoactive drug support, the patient still presented with persistent refractory hypoxemia [pulse oxygen saturation (SpO) 80%-85%] and hemodynamic instability (shock index>1). Emergency contrast-enhanced chest CT revealed embolism in the right main pulmonary artery. Upon consultation from the external hospital, the Pulmonary Embolism Response Team (PERT) of The Fourth Affiliated Hospital of Guangxi Medical University immediately initiated cross-regional rescue. Upon arrival at the external hospital, the modified venous-arterial extracorporeal membr
Abstract
High-risk pulmonary embolism is characterized by acute onset, rapid progression, and high mortality, underscoring the critical need for establishing an efficient multidisciplinary collaborative rescue system. This article reports the successful management of a 61-year-old male patient with high-risk pulmonary embolism following multiple injuries from a fall and subsequent deep vein thrombosis. In August 2024, the patient was admitted to The Fourth Affiliated Hospital of Guangxi Medical University with the chief complaint of "5 days of general multiple traumas after a fall and 8 hours of dyspnea". Five days prior to admission, the patient was hospitalized at The First People's Hospital of Hechi City for multiple injuries caused by a fall, during which an inferior vena cava filter was placed due to lower extremity deep vein thrombosis. The day after filter implantation, the patient developed dyspnea. Despite mechanical ventilation and vasoactive drug support, the patient still presented with persistent refractory hypoxemia [pulse oxygen saturation (SpO) 80%-85%] and hemodynamic instability (shock index>1). Emergency contrast-enhanced chest CT revealed embolism in the right main pulmonary artery. Upon consultation from the external hospital, the Pulmonary Embolism Response Team (PERT) of The Fourth Affiliated Hospital of Guangxi Medical University immediately initiated cross-regional rescue. Upon arrival at the external hospital, the modified venous-arterial extracorporeal membrane oxygenation (V-A ECMO) circuit was emergently established using a Crescent dual-lumen catheter to stabilize circulation. The patient was then safely transferred back to The Fourth Affiliated Hospital of Guangxi Medical University under ECMO support, and underwent emergency interventional pulmonary thrombectomy using the AngioJet system. Postoperatively, hemodynamic and blood oxygen parameters improved significantly. ECMO was successfully removed on the first postoperative day, with a total ECMO run time of approximately 28 hours. After ECMO weaning, the arterial oxygen saturation (SaO) reached 97.8% with face mask oxygen, and the shock index decreased to 0.83. The patient was able to ambulate on the 5th postoperative day without chest tightness or dyspnea. Telephone follow-ups at 3, 6, and 12 months showed favorable recovery. The successful rescue of this patient validates the effectiveness and feasibility of the integrated model of "cross-regional PERT collaboration-modified V-A ECMO support-interventional surgery" for high-risk pulmonary embolism patients with transfer risks. This model enables the rapid and safe establishment of advanced life support, creating conditions for subsequent interventional surgery, and is an effective strategy for managing such complex high-risk pulmonary embolism cases. However, the optimization of the overall workflow and its generalizability still require further practice and verification through larger-sample clinical studies.