3b463b87280544ec368be4aadac9f610 jcm-14-02704.pdf 3817205b59039ad0652ecd8c558131c664834113 jcm-14-02704.pdf 543e8f837c8b430f2220a344643291f9b4cd335725acb74f0a54c812ac755150 jcm-14-02704.pdf Title: Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism Subject: Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged 18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 11660.86 and 2388.50 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA. Keywords: pulmonary embolism; pulmonary mechanical thrombectomy; hemodynamic instability; hypotension; cardiorespiratory arrest Author: Susana González-Suárez, John Camacho Oviedo, José Maria Suriñach Caralt, Maria Grao Roca, Isuru M. Dammala Liyanage, Mercedes Pérez Lafuente, Elisabeth Mena Muñoz, Carla González Junyent, María Martínez-Martínez, Daniel Barnés Navarro and Juan Carlos Ruíz-Rodríguez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Apr 15 13:52:56 2025 CEST ModDate: Tue Apr 15 13:56:34 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1753203 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- MIKRSI+VnURWPalladioL Type 1 Custom yes yes yes 10 0 RMGHNA+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 XXCJNH+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 TFRZDV+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 FFDGWE+CMSY10 Type 1 Builtin yes yes yes 32 0 CKBPVA+EURM10 Type 1 Builtin yes yes yes 56 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 64 0 IOCEJH+CambriaMath CID TrueType Identity-H yes yes yes 79 0 IOCBNA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 85 0 IOCBNB+PalatinoLinotype CID TrueType Identity-H yes yes yes 88 0 IOCBNC+PalatinoLinotype TrueType WinAnsi yes yes no 94 0 IOCBNE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 97 0 IOCCHB+PalatinoLinotype TrueType MacRoman yes yes no 100 0 IOCEJH+CambriaMath CID TrueType Identity-H yes yes yes 114 0 IOCBNA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 120 0 IOCBNB+PalatinoLinotype CID TrueType Identity-H yes yes yes 123 0 IOCBNC+PalatinoLinotype TrueType WinAnsi yes yes no 129 0 IOCBNE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 132 0 IOCCHB+PalatinoLinotype TrueType MacRoman yes yes no 135 0 IOCEJH+CambriaMath CID TrueType Identity-H yes yes yes 147 0 IOCBNA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 153 0 IOCBNB+PalatinoLinotype CID TrueType Identity-H yes yes yes 156 0 IOCBNC+PalatinoLinotype TrueType WinAnsi yes yes no 162 0 IOCBNE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 165 0 IOCCHB+PalatinoLinotype TrueType MacRoman yes yes no 168 0 IOCBNA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 191 0 IOCBNB+PalatinoLinotype CID TrueType Identity-H yes yes yes 194 0 IOCBNC+PalatinoLinotype TrueType WinAnsi yes yes no 200 0 IOCBNE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 203 0 IOCCHB+PalatinoLinotype TrueType MacRoman yes yes no 206 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-05-08 02:45:51 CEST RepresentationInformation: jcm-14-02704.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-05-07 03:50:41 CEST Size: 1753203 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 371 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Ethics Statement and Regulation Destination: subsection.2.1 Item: Title: Study Design and Participants Destination: subsection.2.2 Item: Title: Study Outcomes Destination: subsection.2.3 Item: Title: Data Collection and Data Measurement Destination: subsection.2.4 Item: Title: Data Analysis and Statistical Plan Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Underlying Conditions and PE Etiology According to the Occurrence of CA Destination: subsection.3.1 Item: Title: Hemodynamic and/or Respiratory Support Destination: subsection.3.2 Item: Title: Anesthesia During PMT Destination: subsection.3.3 Item: Title: Mortality Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism Author: Susana González-Suárez, John Camacho Oviedo, José Maria Suriñach Caralt, Maria Grao Roca, Isuru M. Dammala Liyanage, Mercedes Pérez Lafuente, Elisabeth Mena Muñoz, Carla González Junyent, María Martínez-Martínez, Daniel Barnés Navarro and Juan Carlos Ruíz-Rodríguez Subject: Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged 18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 11660.86 and 2388.50 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA. 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