ABSTRACT
Extracorporeal membrane oxygenation (ECMO) was introduced to clinical medicine over 40 years ago. While initially used as a treatment for acute respiratory failure in infants, the use of ECMO has grown to include respiratory and circulatory failure in both children and adults, cardiogenic shock, pulmonary embolism, sepsis, trauma, malignancy, pulmonary hemorrhage and as a treatment for hypothermic drowning.(1) Recent technological improvements in ECMO circuitry make it possible to minimize anticoagulation of the ECMO patient, decreasing the incidence of bleeding. Thrombus deposition within the ECMO circuit can be a life-threating complication. ECMO circuit thrombus can be contained in the circuit, adherent to cannula and deposited within the patient. The ability to remove thrombus while the patient remains on ECMO support could be a life-saving measure for some patients. The present case report outlines use of the AngioVac(®) thrombus removal system in concert with ECMO to remove a large thrombus adherent to an ECMO cannula.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Mechanical Thrombolysis , Thrombosis/therapy , Child , Humans , Male , Mechanical Thrombolysis/instrumentation , Mechanical Thrombolysis/methodsABSTRACT
The Abiomed Impella(®) 2.5 is a micro-axial flow, catheter-based left ventricular assist system (LVAS). Designed for percutaneous insertion into the femoral artery and positioned across the aortic valve, the Impella(®) is capable of pumping 2.5 liters of blood per minute from the patient's left ventricle into the ascending aorta. Since United States Federal Food and Drug Administration clearance in June of 2008, use of the Impella(®) 2.5 has grown rapidly. We operate at the center of a "hub-and-spoke" regional referral network that facilitates the transfer of patients in cardiogenic shock to our facility for definitive care. Based on our recent experience of transporting patients supported on the Impella(®) 2.5 system, we review system operation, pump position, monitoring, and recommendations for providing safe and efficient transport.
Subject(s)
Heart Ventricles/surgery , Heart-Assist Devices , Shock, Cardiogenic/surgery , Transportation of Patients , Catheters , Equipment Design , Heart-Assist Devices/adverse effects , Humans , Transportation of Patients/methodsABSTRACT
Massive pulmonary embolism (PE) is associated, historically, with a high mortality rate.Treatment options include systemic anticoagulation, catheter-directed thrombolytic therapy, surgical embolectomy, fragmentation techniques, and catheter embolectomy. Extracorporeal membrane oxygenation (ECMO) repeatedly has demonstrated effectiveness in providing cardiopulmonary support for the patient with a massive PE too unstable to undergo thrombolysis or embolectomy. The present case study describes a morbidly obese patient, status post gastric bypass surgery, who presented with PE, and acute respiratory and cardiac failure. A description of the patient's management plan, which includes a simple, rapidly deployed ECMO system (Levitronix CentriMag And Jostra Quadrox D), systemic- and catheter-directed thrombolytic therapy and rheolytic thrombectomy (AngioJet Series 3000, Possis Medical, Minneapolis, MN).
