Abstract：
BACKGROUND: Saddle pulmonary embolism (SPE) represents a rare type of venous thromboembolism that frequently causes circulation collapse and sudden death. While venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been well established as a salvage treatment for SPE-induced circulatory shock, it is infrequently administered in patients with advanced malignancy, especially those with brain metastases, given the potential bleeding complications and an uncertain prognosis. As far, there are rare case reports regarding the successful management of hemodynamic instability secondary to SPE-induced cardiac arrest using VA-ECMO in advanced malignancy patients with brain metastases.
METHODS: A 65-year-old woman presenting with cough and waist discomfort who had a history of lung cancer with brain metastases was admitted to the hospital to receive chemoradiotherapy. She suffered sudden cardiac arrest during hospitalization and returned to spontaneous circulation after receiving a 10-min high-quality cardiopulmonary resuscitation. Pulmonary embolism was suspected due to the collapsed hemodynamics and a distended right ventricle identified by echocardiography. Subsequent computed tomographic pulmonary angiography revealed a massive saddle thrombus straddling the bifurcation of the pulmonary trunk. VA-ECMO with adjusted-dose systemic heparinization was initiated to rescue the unstable hemodynamics despite receiving thrombolytic therapy with alteplase. Immediately afterward, the hemodynamic status of the patient stabilized rapidly. VA-ECMO was successfully discontinued within 72 h of initiation without any clotting or bleeding complications. She was weaned off invasive mechanical ventilation on the 6th day of intensive care unit (ICU) admission and discharged from the ICU 3 days later with good neurological function.
CONCLUSIONS: VA-ECMO may be a \'bridging\' therapy to circulation recovery during reperfusion therapy for SPE-induced hemodynamic collapse in malignancy patients with brain metastases.
METHODS: A 65-year-old woman presenting with cough and waist discomfort who had a history of lung cancer with brain metastases was admitted to the hospital to receive chemoradiotherapy. She suffered sudden cardiac arrest during hospitalization and returned to spontaneous circulation after receiving a 10-min high-quality cardiopulmonary resuscitation. Pulmonary embolism was suspected due to the collapsed hemodynamics and a distended right ventricle identified by echocardiography. Subsequent computed tomographic pulmonary angiography revealed a massive saddle thrombus straddling the bifurcation of the pulmonary trunk. VA-ECMO with adjusted-dose systemic heparinization was initiated to rescue the unstable hemodynamics despite receiving thrombolytic therapy with alteplase. Immediately afterward, the hemodynamic status of the patient stabilized rapidly. VA-ECMO was successfully discontinued within 72 h of initiation without any clotting or bleeding complications. She was weaned off invasive mechanical ventilation on the 6th day of intensive care unit (ICU) admission and discharged from the ICU 3 days later with good neurological function.
CONCLUSIONS: VA-ECMO may be a \'bridging\' therapy to circulation recovery during reperfusion therapy for SPE-induced hemodynamic collapse in malignancy patients with brain metastases.
摘要：
背景：鞍肺栓塞（SPE）是一种罕见的静脉血栓栓塞，经常导致循环崩溃和猝死。虽然静脉动脉体外膜氧合（VA-ECMO）已被公认为SPE引起的循环性休克的抢救治疗，它很少在晚期恶性肿瘤患者中使用，尤其是那些脑转移瘤,考虑到潜在的出血并发症和不确定的预后。到目前为止,在有脑转移的晚期恶性肿瘤患者中,使用VA-ECMO成功治疗SPE诱发的心脏骤停继发的血流动力学不稳定的病例报道很少.
方法：一名65岁女性出现咳嗽和腰部不适，有肺癌伴脑转移史，入院接受放化疗。她在住院期间突然心脏骤停，并在接受10分钟的高质量心肺复苏后恢复了自发循环。由于血流动力学塌陷和超声心动图发现右心室扩张，怀疑是肺栓塞。随后的计算机断层扫描肺动脉造影显示，横跨肺动脉分叉的大量鞍状血栓。尽管接受了阿替普酶的溶栓治疗，但开始使用调整剂量的全身肝素化的VA-ECMO以挽救不稳定的血流动力学。紧接着，患者的血流动力学状态迅速稳定。VA-ECMO在开始后72小时内成功停用，没有任何凝血或出血并发症。在重症监护病房（ICU）入院第6天，她脱离有创机械通气，并在3天后从ICU出院，神经功能良好。
结论：VA-ECMO可能是SPE引起的恶性脑转移患者血流动力学崩溃的再灌注治疗期间循环恢复的“桥接”疗法。
方法：一名65岁女性出现咳嗽和腰部不适，有肺癌伴脑转移史，入院接受放化疗。她在住院期间突然心脏骤停，并在接受10分钟的高质量心肺复苏后恢复了自发循环。由于血流动力学塌陷和超声心动图发现右心室扩张，怀疑是肺栓塞。随后的计算机断层扫描肺动脉造影显示，横跨肺动脉分叉的大量鞍状血栓。尽管接受了阿替普酶的溶栓治疗，但开始使用调整剂量的全身肝素化的VA-ECMO以挽救不稳定的血流动力学。紧接着，患者的血流动力学状态迅速稳定。VA-ECMO在开始后72小时内成功停用，没有任何凝血或出血并发症。在重症监护病房（ICU）入院第6天，她脱离有创机械通气，并在3天后从ICU出院，神经功能良好。
结论：VA-ECMO可能是SPE引起的恶性脑转移患者血流动力学崩溃的再灌注治疗期间循环恢复的“桥接”疗法。
