SHM Converge Scientific Abstract ePoster Gallery-Impella Rp Flex in Massive Pulmonary Embolism With Obstructive Shock

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This poster presents a case of massive pulmonary embolism (PE) complicated by obstructive shock, severe right ventricular (RV) failure, and cardiac arrest in a 46-year-old man with no significant past medical history. He initially presented with one week of worsening dyspnea, fatigue, and weakness. Imaging showed bilateral PE with a saddle embolus, left lower lobe infarction, and right heart strain. He was started on heparin and later received tenecteplase for massive PE with RV failure.<br /><br />Despite thrombolysis, the patient rapidly deteriorated overnight with hypotension, hypoxemia, diaphoresis, and ultimately cardiac arrest, requiring CPR with return of spontaneous circulation after four cycles. He was placed on vasopressors and mechanical ventilation. Echocardiography confirmed severe RV systolic dysfunction and acute cor pulmonale. The team performed rescue mechanical thrombectomy with Impella RP support the same day. He developed transient acute kidney injury and ischemic hepatitis after arrest.<br /><br />After Impella RP placement, his vasopressor needs decreased and oxygenation improved by day two. The device was removed on day two, and he was off pressors by day three. He was weaned from mechanical ventilation within a week, with resolution of a transient posterior pericardial effusion. Anticoagulation was transitioned to apixaban and then rivaroxaban, and carvedilol was started for sinus tachycardia. He was discharged hemodynamically stable with close outpatient follow-up.<br /><br />The poster concludes that Impella RP may serve as a useful bridge to definitive therapy in patients with massive PE and refractory RV failure, offering rapid hemodynamic stabilization. However, its use should be individualized, and further studies are needed to define its safety, effectiveness, and role compared with other mechanical circulatory support options.

Asset Subtitle

Srushti N. Ghetiya

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Author List Abinaya Sivakumar, Chandra Kodavanti, Darius Aliabadi, Elizabeth Lirette, Gaurab K.C., Jewell George, Kevin Meek, Milan Regmi, Mina Saba, Sagar Madan, Siddharth Sharma, Somaye Rezaei, Srushti N. Ghetiya, Yoseph Herpo

Category Clinical Vignettes

Concept Massive Pulmonary Embolism

Concept Obstructive Shock

Concept Right Ventricular Failure

Concept Percutaneous Right Ventricular Assist Device

Concept Thrombolytic Therapy

Distinguished Non-Finalist

Presenter Organization Southeast Health Alabama

Presenting Author Srushti N. Ghetiya

Track Adult

Keywords

massive pulmonary embolism

obstructive shock

right ventricular failure

cardiac arrest

tenecteplase

mechanical thrombectomy

Impella RP

acute cor pulmonale

vasopressors

anticoagulation

Massive Pulmonary Embolism

Obstructive Shock

Right Ventricular Failure

Percutaneous Right Ventricular Assist Device

Thrombolytic Therapy