{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:01:51Z","timestamp":1780088511073,"version":"3.54.0"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Philipps-Universit\u00e4t Marburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (&gt;30 mmol\/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE.<\/jats:p>","DOI":"10.3390\/reports8030100","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T08:23:22Z","timestamp":1750839802000},"page":"100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report of Successful Extracorporeal CPR (eCPR) in Refractory Cardiac Arrest Caused by Fulminant Pulmonary Embolism with Remarkable Recovery"],"prefix":"10.3390","volume":"8","author":[{"given":"Lukas","family":"Harbaum","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universit\u00e4t Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1179-6265","authenticated-orcid":false,"given":"Klevis","family":"Mihali","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universit\u00e4t Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0526-7989","authenticated-orcid":false,"given":"Felix","family":"Ausb\u00fcttel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universit\u00e4t Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Schieffer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universit\u00e4t Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Kreutz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps Universit\u00e4t Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5761\/atcs.ra.19-00158","article-title":"Current Management of Acute Pulmonary Embolism","volume":"26","author":"McCurdy","year":"2020","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1159\/000501342","article-title":"Pulmonary Embolism and Gas Exchange","volume":"98","author":"Fernandes","year":"2019","journal-title":"Respiration"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/0003-4975(91)91288-7","article-title":"Fulminant pulmonary embolism: Symptoms, diagnostics, operative technique, and results","volume":"52","author":"Schmid","year":"1991","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00392-018-1366-4","article-title":"Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): Consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC","volume":"108","author":"Michels","year":"2019","journal-title":"Clin. Res. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2016.12.011","article-title":"Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. 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Intensive Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100297","DOI":"10.1016\/j.resplu.2022.100297","article-title":"Videolaryngoscopy versus direct laryngoscopy for endotracheal intubation of cardiac arrest patients in hospital: A systematic literature review","volume":"11","author":"Cox","year":"2022","journal-title":"Resusc. Plus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.amj.2019.06.004","article-title":"First-Pass Success Intubations Using Video Laryngoscopy Versus Direct Laryngoscopy: A Retrospective Prehospital Ambulance Service Study","volume":"38","author":"Eberlein","year":"2019","journal-title":"Air. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/EJA.0000000000001286","article-title":"First pass success of tracheal intubation using the C-MAC PM videolaryngoscope as first-line device in prehospital cardiac arrest compared with other emergencies","volume":"38","author":"Hossfeld","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s44158-024-00195-x","article-title":"Airway management and ventilation techniques in resuscitation during advanced life support: An update","volume":"4","author":"Kill","year":"2024","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s00063-022-00913-9","article-title":"Extrakorporale Reanimation\u2014Kriterien, Bedingungen, Outcome","volume":"117","author":"Magnet","year":"2022","journal-title":"Med. Klin. Intensiv. 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An analysis of the ELSO database","volume":"191","author":"Rivers","year":"2023","journal-title":"Resuscitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.resuscitation.2021.02.011","article-title":"European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances","volume":"161","author":"Lott","year":"2021","journal-title":"Resuscitation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1007\/s00134-025-07805-4","article-title":"Management of high-risk acute pulmonary embolism: An emulated target trial analysis","volume":"51","author":"Stadlbauer","year":"2025","journal-title":"Intensive Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.resuscitation.2021.10.007","article-title":"Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism","volume":"170","author":"Hobohm","year":"2022","journal-title":"Resuscitation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e015291","DOI":"10.1161\/JAHA.119.015291","article-title":"Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Adult Patients","volume":"9","author":"Inoue","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/CCM.0000000000004828","article-title":"Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review","volume":"49","author":"Scott","year":"2021","journal-title":"Crit. 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