Management of cardiac arrest caused by acute massive pulmonary thromboembolism: Importance of percutaneous cardiopulmonary support

Cardiac arrest caused by acute pulmonary embolism is associated with high patient mortality. We reviewed patients who had cardiac arrest caused by acute pulmonary embolism. Between January 2001 and September 2013, we identified 20 patients at our institution with a confirmative diagnosis of acute pulmonary thromboembolism and cardiac arrest. Percutaneous cardiopulmonary support (PCPS) and surgical embolectomy are the standard course of care for patients with shock or cardiac arrest caused by pulmonary thromboembolism at our institution. Patients were divided into two groups (PCPS group and non-PCPS group). Percutaneous cardiopulmonary support was used in 60% of patients. Surgical embolectomy was performed for 85% of patients. Overall in-hospital and surgical mortalities were 35% and 29%, respectively. On the basis of the multivariate analysis, both cardiopulmonary resuscitation more than 15 minutes and absence of PCPS were significant risk factors affecting survival (p = 0.001 and 0.049, respectively). When the duration of cardiac arrest is short, surgical embolectomy is a viable option after cardiac arrest caused by pulmonary thromboembolism. Percutaneous cardiopulmonary support may be a useful tool for both stabilizing the patient and providing a bridge when deciding on further management options.