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Massive postpartum pulmonary embolism successfully treated with v-a-v ECMO: a case report

Pulmonary embolism (PE) is a serious condition that occurs in 1 of 1000–3000 pregnancies (Sultan et al. 2013). It can cause life-threatening cardiorespiratory failure leading to cardiac arrest. In developed countries, all thromboembolic events comprise 14.9% of all maternal deaths (Cristina-Rossi and Mullin 2012). The management of PE for non-pregnant patients includes removal of the clot by using surgical or percutaneous embolectomy or thrombolysis (Martillotti et al. 2017). Pregnancy is considered to be a relative contraindication for thrombolysis because it can lead to massive maternal bleeding (Kearon et al. 2016). Extracorporeal membrane oxygenation (ECMO) with anticoagulation therapy is also mentioned as a possible method for the treatment of pulmonary embolism (Agerstrand et al. 2016). However, there are only a few cases or case series published in the literature, therefore it remains unclear how to deal with these severe cases to achieve the best maternal outcomes. Our aim is to report a successful use of triple cannulation ECMO with anticoagulation therapy for patient, for whom pulmonary embolism occurred within 24 hours after an elective caesarean section.