Key result
SBP < 90 mmHg during PE thrombectomy is linked to ~34-fold higher cardiac arrest risk.
Why the study?
The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients undergoing pulmonary mechanical thrombectomy for high-risk or intermediate-high-risk pulmonary embolism remain poorly understood.
What are the predictors of cardiac arrest in patients undergoing pulmonary mechanical thrombectomy for pulmonary embolism?
Observational (n=98)
No
What are the predictors of cardiac arrest in patients undergoing pulmonary mechanical thrombectomy for pulmonary embolism?
Odds Ratio: 33.534 (95% CI 7.296–154.12)
p-value: p=<0.001
In patients undergoing pulmonary mechanical thrombectomy for pulmonary embolism, male sex, pre-existing respiratory disease, SpO2 < 90%, SBP < 90 mmHg, and elevated NT-proBNP are significant predictors of cardiac arrest.
Hypotension flags high periprocedural arrest risk; hypothesis-generating for prospective risk stratification in PE thrombectomy.
Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660.86 and 2388.50 ± 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA.
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González-Suárez et al. (2025) conducted an observational in Pulmonary embolism (n=98). Systolic blood pressure < 90 mmHg vs. Systolic blood pressure ≥ 90 mmHg was evaluated on Cardiac arrest (OR 33.534, 95% CI 7.296-154.120, p=<0.001). In patients undergoing pulmonary mechanical thrombectomy for pulmonary embolism, systolic blood pressure < 90 mmHg was associated with a 33-fold increased risk of cardiac arrest (OR 33.534).
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