Resuscitation and circulatory support using extracorporeal membrane oxygenation for fulminant pulmonary embolism

Fulminant pulmonary embolism (PE) with circulatory collapse is associated w ith a high mortality rate due to acute right ventricular failure and hypoxi a. Immediate and appropriate resuscitation and circulatory support in the p erioperative period is mandatory to prevent sudden death. Extracorporeal me mbrane oxygenation (ECMO) was recently introduced for extracorporeal life s upport in patients with circulatory collapse and has provided an excellent outcome. We report on the effectiveness of ECMO support for fulminant PE. S even patients were placed on veno-arterial ECMO for circulatory collapse ca used by fulminant PE refractory to conventional treatment. After resuscitat ion, all patients underwent pulmonary angiography, and thrombolytic therapy was administered in all 7 patients under ECMO support. Three patients who did not improve by thrombolysis underwent embolectomy with standard cardiop ulmonary bypass. Two thrombolysis and 2 surgery patients were weaned from b ypass and survived. The duration of support ranged from 18-168 h (mean = 67 .8 +/- 67.1 h), with maximum bypass flow rates of 2.0-4.5 (mean = 3.5 +/- 0 .9). There were no device-related complications during support. In total, 4 patients (57%) were successfully weaned from support and discharged from t he hospital in good condition. All patients who survived required prolonged support (27, 82, 151, and 168 h). We conclude that resuscitation and circu latory support using ECMO can be effective, life-saving measures in cases o f circulatory collapse caused by fulminant PE.