Study Population
During the study period, a total of 154 patients with high-risk PE were
identified, of whom 29 patients with high risk PE, complicated by
cardiogenic shock or that required CPR were treated with ECMO in
conjunction with EKOS APT. The baseline clinical characteristics of the
patients are summarized in Table 1. Twelve of 29 patients placed on ECMO
with cardiac arrest were female and mean age 55.3 ± 9.2 years. The
majority of patients had major transient risk factors for VTE, such as
surgery, immobilization, or prolonged bed rest. Nine patients (31%) had
a prior history of VTE, 5 (17.2%) patients have malignancy, 7 (24.1%)
patients have positive hypercoagulable work-up after presentation. The
most frequent comorbidities were hypertension (48.2%), smoking
(55.1%), and cardiovascular disease (20.6%).
Mean SAPS II and SOFA score were high, respectively, 78.3 ± 14.5 and
13.1 ± 3.8. All patients required hemodynamic support with vasoactive
drugs, resulting in a mean inotrope score of 117 ± 16.3 (20–197)
μg/kg/min at ECMO cannulation. The mean troponin level was 2.12 ± 0.37
ng/mL and the mean pro-B-type natriuretic peptide (pro-BNP) level was
3255 ± 1170 pg/L. Pre-ECMO mean blood pressure, pH and blood lactate
was, respectively: 55.6 ± 7.7 mmHg, 7.11 ± 0.13 and 12.5 ± 2.6 mmol/L
(Table 2). Transthoracic or transesophageal echocardiography visualized
major RV dilation in all patients (mean RV/LV dimensions ratio 1.7 ± 0.3
[1.1–1.9]). On computed tomography (CT) scan, 11 patients (38%)
had saddle PE and an additional six patients (20.6%) had
clot-in-transit in the right atrium. Pulmonary angiographic findings
showed that a filling defect or total occlusion was observed in all 29
the patients at the proximal lobar or lobular arteries and additionally
11 of them had massive thrombus in the main pulmonary arteries. Figure
3A showed large saddle thrombus in main pulmonary artery in CT with
contrast enhancement.