{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:41:54Z","timestamp":1782823314621,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u226518 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 &lt; 90 mmHg increases the risk of CA by 33 (p &lt; 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO2 &lt;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 \u00b1 11660.86 and 2388.50 \u00b1 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 &lt; 90%, and SBP &lt; 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA.<\/jats:p>","DOI":"10.3390\/jcm14082704","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T08:11:39Z","timestamp":1744704699000},"page":"2704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism"],"prefix":"10.3390","volume":"14","author":[{"given":"Susana","family":"Gonz\u00e1lez-Su\u00e1rez","sequence":"first","affiliation":[{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona, Unitat Docent Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Department of Anesthesiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Cardiovascular Diseases Research Group, Vall d\u2019Hebron Institut de Recerca (VHIR), Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Camacho Oviedo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Maria","family":"Suri\u00f1ach Caralt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, Unitat Docent Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Department of Internal Medicine, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Grao Roca","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isuru M.","family":"Dammala Liyanage","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"P\u00e9rez Lafuente","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Mena Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Gonz\u00e1lez Junyent","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Mart\u00ednez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d\u2019Hebron Institut de Recerca (VHIR), Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Barn\u00e9s Navarro","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Ru\u00edz-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Hospital Universitari Vall d\u2019Hebron, Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d\u2019Hebron Institut de Recerca (VHIR), Pg. de la Vall d\u2019Hebron, 119-129, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1076029619853037","DOI":"10.1177\/1076029619853037","article-title":"Diagnosis, treatment and follow up of acute pulmonary embolism: Consensus practice from the pert consortium","volume":"25","author":"McDaniel","year":"2019","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E774","DOI":"10.1161\/CIR.0000000000000707","article-title":"Interventional Therapies for acute pulmonary embolism: Current status and principles for the development of novel evidence: A scientific statement from the American Heart Association","volume":"140","author":"Giri","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jcin.2018.12.022","article-title":"A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-riskacute pulmonary embolism: The FLARE study","volume":"12","author":"Tu","year":"2019","journal-title":"J. Am. Coll. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.ihj.2018.01.014","article-title":"Cardiac arrest due to pulmonary embolism","volume":"70","author":"Laher","year":"2018","journal-title":"Indian Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.resuscitation.2014.11.007","article-title":"Causes of in-hospital cardiac arrest\u2014Incidences and rate of recognition","volume":"87","author":"Bergum","year":"2015","journal-title":"Resuscitation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1001\/archinte.160.10.1529","article-title":"Pulmonary embolism as a cause of cardiac arrest: Presentation and outcome","volume":"160","author":"Meron","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Peracaula, M., Sebastian, L., Francisco, I., Vilaplana, M.B., Rodr\u00edguez-Chiarad\u00eda, D.A., and Tura-Ceide, O. (2024). Decoding pulmonary embolism: Pathophysiology, diagnosis, and treatment. Biomedicines, 12.","DOI":"10.3390\/biomedicines12091936"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.jvsv.2023.03.016","article-title":"Cardiovascular collapse during mechanical thrombectomy for acute pulmonary embolism and the role of extracorporeal membrane oxygenation in patient rescue","volume":"11","author":"Benfor","year":"2023","journal-title":"J. Vasc. Surgery Venous Lymphat. Disord."},{"key":"ref_10","first-page":"101124","article-title":"Mechanical Thrombectomy for High-Risk Pulmonary Embolism: Insights from the US Cohort of the FLASH Registry","volume":"3","author":"Horowitz","year":"2023","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liu, X., Zheng, L., Han, J., Song, L., Geng, H., and Liu, Y. (2021). Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-94346-7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102437","DOI":"10.1016\/j.cpcardiol.2024.102437","article-title":"The significance of B-type natriuretic peptide in predicting early mortality among pulmonary embolism patients, alongside troponin: Insights from a multicentric registry","volume":"49","author":"Boris","year":"2024","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.bja.2021.01.005","article-title":"Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: A systematic review and expert consensus statement","volume":"126","author":"Price","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"154317","DOI":"10.1016\/j.jcrc.2023.154317","article-title":"Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials","volume":"77","author":"Kotani","year":"2023","journal-title":"J. Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111281","DOI":"10.1016\/j.jclinane.2023.111281","article-title":"Anesthetic management in patients having catheter-based thrombectomy for acute pulmonary embolism: A narrative review","volume":"92","author":"Rossler","year":"2023","journal-title":"J. Clin. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/MEJ.0000000000000420","article-title":"Severe pulmonary embolism managed with high-flow nasal cannula oxygen therapy","volume":"24","author":"Messika","year":"2017","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"463.e1","DOI":"10.1016\/j.ajem.2012.08.030","article-title":"High-flow oxygen, a therapeutic bridge while awaiting thrombolysis in pulmonary embolism?","volume":"31","author":"Lacroix","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.bjae.2021.01.002","article-title":"The cardiovascular effects of positive pressure ventilation","volume":"21","author":"Corp","year":"2021","journal-title":"BJA Educ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12947-019-0165-z","article-title":"General anesthesia and positive pressure ventilation suppress left and right ventricular myocardial shortening in patients without myocardial disease\u2014A strain echocardiography study","volume":"17","author":"Dalla","year":"2019","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e623","DOI":"10.4244\/EIJ-D-22-00246","article-title":"Percutaneous treatment options for acute pulmonary embolism: A clinical consensus statement by the ESC working group on pulmonary circulation and right ventricular function and the European Association of Percutaneous Cardiovascular Interventions","volume":"18","author":"Pruszczyk","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8850666241285862","DOI":"10.1177\/08850666241285862","article-title":"Intubation and mechanical ventilation in patients with acute pulmonary embolism: A scoping review","volume":"25","author":"Lee","year":"2024","journal-title":"J. Intensive Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/175114371301400109","article-title":"Pulmonary embolism in the mechanically-ventilated critically ill patient: Is it different?","volume":"14","author":"Zochios","year":"2013","journal-title":"J. Intensive Care Soc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.amjmed.2020.03.058","article-title":"Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team","volume":"133","author":"Carroll","year":"2020","journal-title":"Am. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.thromres.2012.08.292","article-title":"Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian pulmonary embolism registry (IPER)","volume":"130","author":"Casazza","year":"2012","journal-title":"Thromb. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"780786","DOI":"10.1183\/13993003.00024-2016","article-title":"Acute pulmonary embolism: Mortality prediction by the 2014 European society of cardiology risk stratification model","volume":"48","author":"Becattini","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/j.amjmed.2018.07.035","article-title":"Contemporary management and outcomes of patients with massive and submassive pulmonary embolism","volume":"131","author":"Secemsky","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.amjmed.2021.01.026","article-title":"Nineteen-year trends in mortality of patients hospitalized in the United States with high-risk pulmonary embolism","volume":"134","author":"Stein","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1161\/CIRCINTERVENTIONS.123.013406","article-title":"Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy: Results from The FLAME Study","volume":"16","author":"Silver","year":"2023","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.4244\/EIJ-D-22-00732","article-title":"Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism","volume":"18","author":"Toma","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1378\/chest.15-0119","article-title":"Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT)Initial Results from a Prospective Multicenter Registry","volume":"148","author":"Kuo","year":"2015","journal-title":"Chest"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jacc.2018.11.038","article-title":"Venoarterial ECMO for adults: JACC scientific expert panel","volume":"73","author":"Guglin","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e004905","DOI":"10.1161\/CIRCHEARTFAILURE.118.004905","article-title":"Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest","volume":"11","author":"Rao","year":"2018","journal-title":"Circ. Heart Fail."},{"key":"ref_33","first-page":"445","article-title":"Percutaneous circulatory assist devices for right ventricular failure","volume":"2","author":"Kapur","year":"2013","journal-title":"Interv. Cardiol. Clin."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1161\/CIRCULATIONAHA.116.025290","article-title":"Mechanical circulatory support devices for acute right ventricular failure","volume":"136","author":"Kapur","year":"2017","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ijcard.2018.10.001","article-title":"Incidence, mortality and bleeding rates associated with pulmonary embolism in England between 1997 and 2015","volume":"277","author":"Kempny","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/0267659115583682","article-title":"Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients\u2014A case series","volume":"31","author":"Swol","year":"2016","journal-title":"Perfusion"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e175","DOI":"10.1016\/j.resuscitation.2014.03.309","article-title":"ECLS management in pulmonary embolism with cardiac arrest: Which strategy is better?","volume":"85","author":"Maj","year":"2014","journal-title":"Resuscitation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/j.resuscitation.2013.03.032","article-title":"Pulmonary embolectomy in high-risk acute pulmonary embolism: The effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support","volume":"84","author":"Wu","year":"2013","journal-title":"Resuscitation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1177\/0267659115583377","article-title":"Extracorporeal membrane oxygenation in acute massive pulmonary embolism: A systematic review","volume":"30","author":"Yusuff","year":"2015","journal-title":"Perfusion"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s10877-015-9796-2","article-title":"Massive pulmonary embolism leading to cardiac arrest: One pathology, two different ECMO modes to assist patients","volume":"30","author":"Giraud","year":"2016","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.medcli.2024.04.024","article-title":"Terapia dirigida por cat\u00e9ter en embolia pulmonar de alto riesgo: An\u00e1lisis de 9 casos Catheter directed therapy in high-risk pulmonary embolism: Analysis of 9 cases","volume":"163","year":"2024","journal-title":"Med. Clin."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Tsangaris, A., Alexy, T., Kalra, R., Kosmopoulos, M., Elliott, A., Bartos, J.A., and Yannopoulos, D. (2021). Overview of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the management of cardiogenic shock. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.686558"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.21037\/jtd-21-1770","article-title":"Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: Single-center experience with 679 patients","volume":"14","author":"Sahli","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00270-022-03266-0","article-title":"Percutaneous large-bore pulmonary thrombectomy with the FlowTrierver Device: Initial experience in intermediate-high and high-risk patients","volume":"46","author":"Luedemann","year":"2022","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2217\/fca-2022-0134","article-title":"Indigo\u00ae aspiration system for thrombectomy in pulmonary embolism","volume":"19","author":"Raza","year":"2023","journal-title":"Futur. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2704\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:59Z","timestamp":1760030099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14082704"],"URL":"https:\/\/doi.org\/10.3390\/jcm14082704","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]}}}