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Massive Pulmonary Embolism (massive + pulmonary_embolism)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Thrombelastometry-guided thrombolytic therapy in massive pulmonary artery embolism

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010
A. PLOPPA
We report a case of a patient who suffered a massive pulmonary embolism with cardiac arrest on post-operative day 4 after a Whipple operation. Despite thrombolytic therapy with the recommended maximal bolus of 50 mg recombinant tissue type plasminogen activator (rt-PA), thrombelastometry showed no signs of fibrinolysis and cardiogenic shock persisted, after only a transient hemodynamic improvement. Not until a repeat bolus of 25 mg rt-PA and an infusion of 50 mg/h did thrombelastometry demonstrate complete fibrinolysis. Although only residual emboli were seen on computed tomography, the patient died secondary to refractory right heart failure. This demonstrates that the standard dosing of thrombolytics may fail in a subgroup of patients, and suggests that thrombelastometry may be useful for early dose adjustment when standard dosing regimens fail. [source]

Good neurological recovery after cardiopulmonary resuscitation and thrombolysis in two old patients with pulmonary embolism

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
F. CAVALLARO
The use of thrombolysis as an emergency treatment for cardiac arrest (CA) due to massive pulmonary embolism (MPE) has been described. However, there are no reports of successful treatment of MPE-associated CA in patients over 77 years of age. We report two cases of successful cardiopulmonary resuscitation for an MPE-associated CA in two very old women (87 and 86 years of age). In both cases, typical signs of MPE were documented using emergency echocardiography, which showed an acute right ventricle enlargement and a paradoxical movement of the interventricular septum. Emergency thrombolysis was administered during resuscitation, which lasted 45 and 21 min, respectively. Despite old age and prolonged resuscitation efforts, both patients had good neurological recovery and one of them was alive and neurologically intact 1 year later. Thrombolysis is a potentially useful therapy in MPE-associated CA. A good neurological outcome can be obtained even in very old patients and after prolonged resuscitation. [source]

Percutaneous mechanical thrombectomy for massive pulmonary embolism: Improve safety and efficacy by sharing information

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2007
Samuel Z. Goldhaber MD
No abstract is available for this article. [source]

Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: Rotational bidirectional thrombectomy (ROBOT)

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2006
Masashi Yoshida MD
Abstract Background: Although thrombolysis is a standard therapy in cases of pulmonary embolism (PE), fatal outcome is often observed. We designed and investigated the efficacy of a novel percutaneous catheter therapy, rotational bidirectional thrombectomy (ROBOT), for PE. Methods and Results: Eighteen patients with acute massive PE (Miller score , 20) were included in this study. We separated them into two groups [group A (n = 10), thrombolysis; group B (n = 8): thrombolysis and ROBOT or ROBOT alone]. There was no difference in the hemodynamic indices between the groups at diagnosis. ROBOT was designed to fragment emboli by rotating a regular pigtail catheter. Three deaths occurred in group A because of hemodynamic impairment, but there was no death in group B. One day after treatment, systolic pulmonary artery pressure had decreased from 53 ± 8 to 30 ± 8 mm Hg (P < 0.05) in group B and from 54 ± 5 to 42 ± 19 mm Hg (NS) in group A. The hospitalization period in group B was shorter than that in group A (17 ± 6 vs. 27 ± 10 days, P < 0.05). Conclusion: ROBOT therapy results in a significant, rapid improvement in the hemodynamic situation and in a better outcome than conventional therapy in patients with acute massive pulmonary embolism. © 2006 Wiley-Liss, Inc. [source]