Key result
Percutaneous thrombectomy with autotransfusion stabilizes massive PE with cardiogenic shock, returning ~50% of aspirated blood.
Why the study?
Does percutaneous thrombectomy combined with autotransfusion improve hemodynamics and clinical outcomes in a patient with massive pulmonary embolism and cardiogenic shock?
Case Report (n=1)
No
Does percutaneous thrombectomy combined with autotransfusion improve hemodynamics and clinical outcomes in a patient with massive pulmonary embolism and cardiogenic shock?
Autotransfusion during percutaneous thrombectomy for massive pulmonary embolism can effectively salvage blood and support hemodynamic stabilization in cardiogenic shock.
Answers are grounded in this paper and cite their sources.
May support stabilization in select massive PE shock cases; leaves open need for prospective trials.
A 64-year-old male patient was admitted to the catheterization laboratory with a suspected myocardial infarction and in cardiogenic shock. Upon further investigation, a massive bilateral pulmonary embolism with signs of right heart dysfunction was discovered, leading to a decision to perform a direct interventional treatment with a thrombectomy device for thrombus aspiration. The procedure was successful in removing almost the entirety of the thrombotic material from the pulmonary arteries. The patient's hemodynamics stabilized and oxygenation improved instantly. The procedure required a total of 18 aspiration cycles. Each aspiration contained approx. 60 mL blood amounting to a total of approx. 1080 mL of blood. During the procedure, a mechanical blood salvage system was used to resupply 50% of the blood via autotransfusion that would otherwise have been lost. The patient was transferred to the intensive care unit for post-interventional care and monitoring. A CT angiography of the pulmonary arteries after the procedure confirmed the presence of only minor residual thrombotic material. The patient's clinical, ECG, echocardiographic, and laboratory parameters returned to normal or near normal ranges. The patient was discharged shortly after in stable conditions on oral anticoagulation.
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Haertel et al. (2023) conducted a case report in Cardiogenic shock due to massive bilateral pulmonary embolism (n=1). Percutaneous thrombectomy with autotransfusion was evaluated on Hemodynamic stabilization, oxygenation improvement, and removal of thrombotic material. Percutaneous thrombectomy with autotransfusion successfully stabilized a patient with cardiogenic shock due to massive pulmonary embolism, resupplying 50% of the 1080 mL aspirated blood.
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