AUTHOR=Gutierrez-Gallegos Paola , Jimenez-Franco Vicente , Jerjes-Sanchez Carlos , Quevedo-Salazar Renata , Rodriguez-Rivera Jahir , Paredes-Gutierrez Enrique , Lira-Lozano Daniel , Quintanilla-Gutierrez Juan , Gomez-Gutierrez Rene , de la Peña-Almaguer Erasmo , Torre-Amione Guillermo 

TITLE=Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1444636

DOI=10.3389/fcvm.2024.1444636

ISSN=2297-055X

ABSTRACT=<p>Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition.</p>