Percutaneous thrombectomy for refractory cardiac arrest due to massive pulmonary embolism in the extracorporeal cardiopulmonary resuscitation era.

Background
Thrombolysis is effective for massive acute pulmonary embolisms (PEs), but also it increases hemorrhagic complications, especially after cardiopulmonary resuscitation. We investigated percutaneous thrombectomy (PTA) for PE patients after refractory cardiac arrest.

Methods
Patients who underwent venoarterial extracorporeal membrane oxygenation (ECMO) after PE-related cardiac arrest between 2006 and 2018 were enrolled in this study. We assessed treatments; clinical findings; and outcomes, including ECMO duration, complications, and 30-day survival.

Results
Among the study patients (N = 31; median age: 64 y; interquartile range: 57 – 68), 14 patients (45%) were male, and 10 (32%) had out-of-hospital cardiac arrests. All patients underwent anticoagulation therapy; one had systemic thrombolysis; 12 had PTA, 8 had thrombolysis + PTA, and 3 had surgical thrombectomy, with corresponding 30-day survivals of 57%, 100%, 25%, 25%, and 33%, respectively. The ECMO duration was significantly shorter in PTA-treated patients than in those treated with anticoagulation alone (28 h [6 – 28 h] vs. 57 h [32 – 120 h]) (Figure), and the red cell blood transfusions were similar between the 2 groups (11 U [2 – 31 U] vs. 8 U [4 – 38 U]). The ECMO durations, blood transfusions (11 U [2 – 31 U] vs. 10 U [2 – 34 U]), and 30-day survivals were similar for patients with PTA alone and those with thrombolysis + PTA.

Conclusions
PTA may shorten the duration of mechanical circulatory support for PE patients with refractory shock. Thrombolysis + PTA may not improve outcomes in patients with refractory shock.