Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation.
Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation.
复制标题
体外膜肺氧合期间超声辅助导管引导肺栓塞溶栓。
DOI：
10.1111/jocs.15622
复制
发表时间：
2021
影响因子：
1.6
通讯作者：
Kaczorowski,DavidJ
中科院分区：
文献类型：
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作者：
Tran,Douglas;Hays,Nicole;Shah,Aakash;Pasrija,Chetan;Cires-Drouet,RafaelS;Toursavadkohi,ShahabA;Mazzeffi,MichaelA;Herr,DanielL;Madathil,RonsonJ;Gammie,JamesS;Griffith,BartleyP;Deatrick,KristopherB;Kaczorowski,DavidJ
研究背景急性肺栓塞（acute pulmonary embolism，PE）是心血管疾病死亡的第三大常见原因.对于血流动力学不稳定的患者，静脉-动脉体外膜肺氧合（VA‐ECMO）支持已被证明可提供血流动力学稳定性，并为确定性治疗和恢复留出时间。超声辅助导管定向溶栓（USAT）有可能成为一种安全的辅助手段，并加快需要VA-ECMO治疗PE的患者的右心室（RV）恢复。这些患者中共有49例因PE而插管。其中6例（12%）患者使用USAT治疗作为辅助治疗。这6例患者使用EKO导管以1 mg/h的组织纤溶酶原激活剂给予标准化USAT治疗，并输注普通肝素进行额外的全身抗凝。在接受USAT作为ECMO.ResultsMedian年龄为54岁的患者队列中检查了结局，包括院内死亡、90天生存率、RV恢复和并发症。6例患者中有5例出现大面积PE，PE严重程度评分为V级。1例患者出现次大面积PE，Bova评分为2，但在RV功能恶化的情况下插管至VA‐ECMO。所有患者均证实右心室功能恢复，无院内死亡，90天随访时均存活。结论Ekosonic血管内系统治疗可能是VA-ECMO治疗PE患者的安全可行的辅助治疗，并允许右心室恢复生存，并发症最少。
BackgroundAcute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound‐assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA‐ECMO for PE.MethodsA review of all VA‐ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in‐hospital death, 90‐day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO.ResultsMedian age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA‐ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in‐hospital death, and were alive at 90‐day follow‐up.ConclusionEkosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA‐ECMO for PE, and allow for survival with RV recovery with minimal complications.