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.