# 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.

## Key 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.