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CRITICAL CARE AND TRAUMA

Acute Pulmonary Artery Embolism During Transcatheter Embolization: Successful Resuscitation with Veno-Arterial Extracorporeal Membrane Oxygenation

Ingrid Haller, MD^*, Agnes Kofler, MD^*, Wolfgang Lederer, MD^*, Andreas Chemelli, MD, and Franz J. Wiedermann, MD^*

From the Departments of *Anesthesiology and Critical Care Medicine, and Radiology, Innsbruck Medical University, Austria.

Address correspondence and reprint requests to Franz J. Wiedermann, MD, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria. Address e-mail to franz.wiedermann{at}i-med.ac.at.

Versatile particles from transcatheter embolization may accidentally enter the pulmonary circulation, causing severe pulmonary embolism. A 36-yr-old woman patient suffering from an arteriovenous malformation in the left shoulder underwent embolization with micro coils, N-butyl-2-cyanoacrylate/lipiodol and polyvinyl alcohol particles. During embolization, acute onset of tachycardia, hypotension, and decline in oxygen saturation indicated right ventricular failure and decreased pulmonary perfusion confirmed by angiography. As mechanical resuscitation failed to stabilize cardiocirculatory function, veno-arterial extracorporeal membrane oxygenation support was preformed until hemodynamic stability was regained. Extracorporeal membrane oxygenation should be considered for cases where pulmonary embolism causes right ventricular failure and circulatory arrest during transcatheter embolization.

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