Depending on the patient’s condition, written or verbally informed consent was obtained. The ethics committee was notified about the inclusion of any mechanically ventilated and sedated patient and consent was obtained as soon as possible in the clinical course.
Ten patients (4 female, 6 male, age 53.8 ± 9.5 years) from three centers were included in the study. Levitra Link The demographic and clinical data are given in Table 1.
Inclusion criteria were angiographically confirmed acute massive pulmonary embolism with hemodynamic impairment (pulmonary arterial occlusion > 50%, mean pulmonary artery pressure > 25 mm Hg, shock index = heart rate/systolic systemic BP > 1) and involvement of the central (main and/or lobar) pulmonary arteries. Hemodynamically stable patients and patients with exclusive involvement of peripheral (segmental/subsegmental) pulmonary arteries were excluded.
All examinations, including pulmonary angiography and the fragmentation procedure, were carried out in an ICU. Patients who showed a rapid deterioration of their cardiopulmonary condition were intubated, sedated, and put on respiratory therapy with oxygen supplementation. Positive inotropic and vasoactive support with catecholamines was supplemented according to the patient’s hemodynamic condition. Prior to pulmonary angiography, bedside transthoracic or transesophageal echocardiography was performed to confirm the suspicion of pulmonary embolism and to exclude right atrial or ventricular floating thrombi. In case of thrombi-in-transit, right heart catheterization was waived. For catheter access, the protocol allowed jugular or femoral puncture, according to the preference of the examiner. However, transfemoral access was considered contraindicated in case of iliocaval or ipsilat-eral femoral venous thrombosis, as documented by vascular ultrasound and subsequent iliocavography. To avoid inadvertent arterial puncture, jugular cannulation was usually performed by ultrasound guidance.
Table 1—Demographic and Clinical Data
|Patient No./ Sex/Age, yr||Height,cm||Weight,kg||History/Primary Diagnosis||CPR Duration, min||Mechanical Ventilation (V), Inotropic Support (I)|
|l/M/47||185||110||Repeated syncopes last 2 wk, recurrent pulmonary embolism, pulmonary hypertension, DVT left leg||—||V, I|
|2/M/66||174||72||Perforated appendix, appendectomy, gastrectomy, DVT right leg||—|
|3/M/53||19-5||100||Trauma: lumbar vertebral body fractures, internal fixation||V. I|
|4/M/36||178||72||Trauma: fractures right leg, cervical spine, DVT right leg||I|
|5/M/58||175||80||Recurrent pulmonary embolism||–||–|
|6/F/70||160||75||Hip endoprothesis||Unknown||V, I|
|7/F/53||166||84||Meningioma, cranial surgery||10||V, I|
|8/F/56||169||82||Cranial trauma, endogenous depression||–||V, I|
|9/F/55||172||93||Transsphenoidal hypophysectomy repeated resuscitations||30||V, I|
|10/M/44||187||94||Cerebral stroke, left hemiparesis||–||V, I|