Frontiers in Cardiovascular Medicine (Jul 2024)

Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report

  • Paola Gutierrez-Gallegos,
  • Vicente Jimenez-Franco,
  • Vicente Jimenez-Franco,
  • Vicente Jimenez-Franco,
  • Carlos Jerjes-Sanchez,
  • Carlos Jerjes-Sanchez,
  • Renata Quevedo-Salazar,
  • Jahir Rodriguez-Rivera,
  • Enrique Paredes-Gutierrez,
  • Daniel Lira-Lozano,
  • Daniel Lira-Lozano,
  • Juan Quintanilla-Gutierrez,
  • Juan Quintanilla-Gutierrez,
  • Juan Quintanilla-Gutierrez,
  • Rene Gomez-Gutierrez,
  • Erasmo de la Peña-Almaguer,
  • Erasmo de la Peña-Almaguer,
  • Erasmo de la Peña-Almaguer,
  • Guillermo Torre-Amione,
  • Guillermo Torre-Amione,
  • Guillermo Torre-Amione

DOI
https://doi.org/10.3389/fcvm.2024.1444636
Journal volume & issue
Vol. 11

Abstract

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Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition.

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