Use of venopulmonary ECMO as a bridge to recovery after surgical thromboembolectomy for high risk pulmonary embolism
TL;DR
Venopulmonary ECMO may provide targeted rescue support after surgical pulmonary thromboembolectomy when refractory RV failure and severe hypoxemia persist despite reperfusion.
Abstract
High-risk pulmonary embolism with persistent right ventricular (RV) failure after reperfusion remains a major therapeutic challenge. We report a 60-year-old man with thrombus in transit and pulmonary embolism who deteriorated despite catheter-directed aspiration and local thrombolysis. Surgical right atrial embolectomy and bilateral pulmonary artery thrombectomy were performed through median sternotomy on normothermic cardiopulmonary bypass. Although separation from bypass was initially successful, severe postoperative RV-predominant cardiogenic shock, pulmonary hypertension, acute kidney injury, and refractory hypoxemia developed. Because left ventricular function was preserved, femoral arterial access was unfavorable, and differential hypoxemia was a concern with peripheral venoarterial ECMO, venopulmonary ECMO was established using femoral venous drainage and pulmonary artery return. Hemodynamics and oxygenation improved promptly, allowing discontinuation of vasoactive support. After six days, RV function recovered and ECMO was successfully removed. Venopulmonary ECMO may provide targeted rescue support after surgical pulmonary thromboembolectomy when refractory RV failure and severe hypoxemia persist despite reperfusion.