Acoustic pulse thrombolysis complemented by ECMO improved survival in patients with high-risk pulmonary embolism

Background The optimal treatment of high-risk pulmonary embolism (PE) with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS (TM) acoustic pulse thrombolysis (APT). Methods From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 +/- 9.2 years. A total of 12 (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after presentation. All patients exhibited acute symptoms, computed tomography evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results Twenty-two patients survived to hospital discharge, with a mean intensive care unit stay of 9.9 +/- 1.6 days (range: 7-22 days) and mean length of hospital stay of 23.7 +/- 8.5 days (range: 11-44 days). Six patients died from refractory shock. Ninety-day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 +/- 1.1 days and the mean RV/LV ratio decreased from 1.31 +/- 0.17 to 0.92 +/- 0.11 in patients who survived to discharge. The mean tissue plasminogen activator dose for survivor patients was 20.5 +/- 1.6 mg. Conclusion Patients with high-risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for the patients who have high-risk PE with circulatory collapse.