Catheter directed thrombolysis combined with ECMO for massive pulmonary emboli

This case report discusses a previously healthy young male who suffered an in hospital cardiac arrest, found to be secondary to massive pulmonary emboli (PE). This patient was not a candidate for PE dosing of tPA, but continued to have worsening cardiogenic shock and acute hypoxic respiratory failure. The decision was made to initiate venoarterial extracorporeal membrane oxygenation (VA ECMO) in combination with catheter assisted thrombolysis. With time, the sequelae of his disease process changed. Although his cardiogenic shock improved, the hypoxemia worsened, and the patient was transitioned from VA to venovenous (VV) ECMO, while managing further complications due to multiple episodes of cardiac arrest and severe coagulopathy with multiple, acute, life-threatening bleeding events. Albeit a growing field, VA and VV ECMO are less than common, individually, however this case reports outlines the even rarer event of transition from VA to VV ECMO in combination with catheter assisted thrombolysis treatment via the EKOS EndoWave Infusion Catheter System. Providing care for critically ill patients often demands a collaborative effort between multiple specialties. This case report exemplifies this collaboration, leading to the combination and unification of alternative treatments: ECMO and catheter assisted thrombolysis.