Successful Surgical Embolectomy Following Veno-Arterial Extracorporeal Membrane Oxygenation in a Taxi Driver With High-Risk Pulmonary Embolism: A Case Report

TL;DR

A taxi driver with severe pulmonary embolism was successfully treated with surgical embolectomy after extracorporeal membrane oxygenation.

Contribution

Demonstrates successful use of VA-ECMO followed by surgical embolectomy in a high-risk pulmonary embolism case with occupational risk factors.

Findings

VA-ECMO and surgical embolectomy saved a patient with cardiogenic shock from massive pulmonary embolism.

Prolonged sitting due to occupation was identified as an underrecognized risk factor for venous thromboembolism.

Early multidisciplinary intervention improved outcomes in a high-risk PE case unresponsive to medical therapy.

Abstract

We report a case of a 51-year-old male taxi driver who developed cardiogenic shock due to massive pulmonary embolism (PE) while working. The patient, with a prior history of myocardial infarction, presented with severe hypoxia, hypotension, and electrocardiographic changes mimicking left main coronary artery infarction. Coronary angiography revealed no significant stenosis, while imaging studies confirmed bilateral central PE and deep vein thrombosis. Despite initial anticoagulation and vasopressor therapy, the patient experienced circulatory collapse, requiring cardiopulmonary resuscitation. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was promptly initiated, followed by successful surgical embolectomy (SE). The postoperative course was favorable, and the patient was discharged on hospital day 30 with full recovery.

This case highlights the diagnostic challenges in differentiating PE from acute coronary syndromes in patients presenting with shock. It also underscores the value of risk stratification using clinical scores, such as the simplified Pulmonary Embolism Severity Index (sPESI), and cardiac biomarkers. Importantly, the patient’s occupation - marked by prolonged sitting - represents a significant but underrecognized risk factor for venous thromboembolism. In high-risk PE cases unresponsive to medical therapy, early implementation of VA-ECMO and SE can be lifesaving. Awareness of occupational risk factors and prompt multidisciplinary intervention are critical to improving outcomes in similar clinical scenarios.

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