Management of Catastrophic Postpartum Acute Pulmonary Embolism With Extracorporeal Membrane Oxygenation Support and Thromboaspiration: A Case Report.

BACKGROUND

Pulmonary embolism (PE) is a leading cause of maternal mortality during the postpartum period and is associated with significant hemodynamic instability. High-risk PE, characterized by obstructive shock and right ventricular failure, requires immediate and aggressive intervention. In cases refractory to conventional therapies, extracorporeal membrane oxygenation (ECMO) may serve as a life-saving bridge to definitive treatment.

CASE DESCRIPTION: We report the case of a 28-year-old woman who developed high-risk acute PE 48 h after an uncomplicated vaginal delivery. She presented with severe obstructive shock and right ventricular failure unresponsive to systemic thrombolysis and standard hemodynamic support. Due to progressive clinical deterioration, venoarterial ECMO was initiated as a rescue therapy, which led to hemodynamic stabilization. Mechanical thromboaspiration was subsequently performed, achieving successful thrombus removal and clinical improvement.

CONCLUSION

This case highlights the critical role of ECMO as a therapeutic bridge in patients with high-risk PE and hemodynamic collapse. The combination of ECMO with catheter-directed thromboaspiration proved effective in restoring hemodynamic stability and resolving thrombotic obstruction, offering a viable rescue strategy in life-threatening postpartum PE.