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Related Experiment Videos

Massive pulmonary embolism: triple-armed therapy.

D Rosenthal1, R D Evans, E Borrero

  • 1Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia, Atlanta.

Journal of Vascular Surgery
|February 1, 1989
PubMed
Summary
This summary is machine-generated.

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Aggressive "triple-armed therapy" for massive pulmonary emboli rapidly improved patient survival and cardiorespiratory function. This combined approach, including thrombolysis and a Greenfield filter, offers a promising alternative to traditional heparin therapy.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Interventional Radiology

Background:

  • Massive pulmonary embolism (PE) carries a high mortality rate despite emergent treatments.
  • Existing therapies like systemic anticoagulation with heparin have limitations in critically ill patients.
  • Pulmonary embolectomy carries significant morbidity, and systemic thrombolytic therapy has associated hazards.

Purpose of the Study:

  • To evaluate the efficacy and safety of a novel
  • triple-armed therapy
  • protocol for patients with massive pulmonary embolism.
  • To compare outcomes of this aggressive combined management with standard heparin therapy.

Main Methods:

  • A prospective study involving 20 patients with massive PE over 5 years.

Related Experiment Videos

  • Intervention group (10 patients): received low-dose topical intrapulmonary thrombolytic therapy (streptokinase or urokinase) via Swan-Ganz catheter, systemic anticoagulation (heparin), and simultaneous Greenfield filter insertion.
  • Control group (10 patients): received systemic heparin alone.
  • Serial pulmonary arteriography was performed daily to assess thrombus resolution.
  • Two additional patients received tissue plasminogen activator as part of the triple-armed therapy.

    • Main Results:

    • The triple-armed therapy group showed rapid (less than 6 hours) and significant improvements in oxygenation (PaO2), pulmonary artery pressure, cardiac output, pulmonary vascular resistance, and blood pressure compared to the heparin-only group.
    • Survival rates were higher in the triple-armed therapy group (9/10) versus the heparin group (6/10).
    • Patients treated with tissue plasminogen activator demonstrated the fastest cardiorespiratory improvement and arteriographic clearance.

    Conclusions:

    • The combined
    • triple-armed therapy
    • protocol is a promising management strategy for massive pulmonary embolism.
    • This approach potentially reduces morbidity associated with pulmonary embolectomy and avoids hazards of systemic thrombolytic therapy.
    • The protocol demonstrates improved survival and cardiorespiratory dynamics in critically ill patients with massive PE.