ECMO-assisted catheter-directed thrombolysis for post-traumatic pulmonary embolism with bilateral atrial thrombi: a retrospective case series
Abstract
BACKGROUND: We retrospectively evaluated the feasibility and short-term outcomes of extracorporeal membrane oxygenation (ECMO)–assisted catheter-directed thrombolysis in this high-risk population and descriptively characterized the accompanying biomarker trajectories. METHODS: We retrospectively reviewed 16 adults presenting 9–13 days post-trauma with CT pulmonary angiography (CTA)-confirmed extensive bilateral PE and transesophageal echocardiography (TEE)-verified atrial thrombi who underwent V-A ECMO–assisted CDT in a single tertiary center. Primary outcomes were imaging-documented thrombus resolution, hemodynamic stabilization, in-hospital survival, and 90-day functional status. A streamlined biomarker panel—including a coagulation profile (D-dimer, fibrinogen, aPTT, anti-Xa, PT/INR), cardiac markers (troponin, BNP), and markers of perfusion/hemolysis (lactate, free hemoglobin, LDH) plus IL-6, and at decreasing frequencies post-wean as a secondary, exploratory monitoring tool. RESULTS: In this retrospective case series of 16 adults with post-traumatic PE and bilateral atrial thrombi, ECMO-assisted catheter-directed thrombolysis was technically feasible in all patients and was not interrupted for device- or access-related complications. Median ECMO duration was 6 days (IQR 5–7), and median hospital stay was 14 days (IQR 12–16). Survival was 15 of 16 (93.8%): one patient died of hemorrhagic shock and one of sepsis. Among survivors, complete radiographic resolution of both…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 16 participants or records.
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