Extracorporeal Life Support as Salvage Therapy for Massive Pulmonary Embolus and Cardiac Arrest in Pregnancy

• Published in: The Journal of emergency medicine 2018-07, Vol.55 (1), p.121-124
• Main Authors: Takacs, Michael E., Damisch, Kristina E.
• Format: Article
• Language: English
• Subjects: critical care; Emergency Service, Hospital - organization & administration; extracorporeal life support; extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Heart Arrest - etiology; Heart Arrest - therapy; Humans; Pregnancy; Pulmonary Embolism - complications; Pulmonary Embolism - therapy; pulmonary embolus; Salvage Therapy - methods; Syncope - etiology; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2018.04.009

Massive pulmonary embolus (PE) with prolonged cardiac arrest in the setting of pregnancy has few treatment options. Selections are further restricted if there are contraindications to the standard therapies of embolectomy and thrombolysis. We report a case of extracorporeal life support (ECLS) used as salvage therapy for a critically ill pregnant patient. A 21-year-old woman presented to a small rural hospital with chest pain, dyspnea, hypoxia, and syncope. In their emergency department, she suffered 2 episodes of cardiac arrest requiring cardiopulmonary resuscitation, and fetal demise followed. A computed tomography scan revealed a saddle PE. She was transferred to our tertiary care hospital and arrived critically ill, on multiple vasopressors, and in cardiogenic shock. Because standard treatments, namely thrombolysis and embolectomy, were contraindicated in this case, ECLS was employed for 7 days. She was discharged home after 23 days, and at follow-up 5 months after her admission, she was found to have made a near-complete recovery. ECLS is a viable option as salvage therapy for pregnant patients with massive PE who have contraindications to thrombolysis and embolectomy.