Beyond Clots: The Role of Cardiac Anesthesiologists in a Case of ECMO for Massive Pulmonary Embolism

TL;DR

A 35-year-old man with a severe blood clot in his lungs was treated with a combination of mechanical and drug-based clot removal, supported by ECMO, and eventually recovered.

Contribution

Highlights the role of cardiac anesthesiologists in managing complex pulmonary embolism cases requiring ECMO and thrombectomy.

Findings

The patient required venoarterial ECMO after cardiogenic shock during thrombectomy.

Catheter-directed thrombolysis was used post-ECMO initiation.

The patient was successfully weaned off ECMO and discharged home after 7 days.

Abstract

We present a case of a 35-year-old male who presented with sudden-onset severe chest pain and breathlessness. CTPA revealed massive bilateral pulmonary embolism. The patient underwent catheter-directed mechanical thrombectomy (CDMT) under general anesthesia, complicated by cardiogenic shock necessitating cardiopulmonary resuscitation (CPR). Post ROSC, venoarterial ECMO was initiated, and catheter-directed thrombolysis was performed. CDMT was reattempted but not fully successful, and the patient developed right heart failure with pulmonary hypertension. ECMO continued for 5 days and gradually weaned off. He was extubated successfully on Day 7 and discharged home later.

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