Evidence map›Paper›PMID 33343036›Full record

ArticleThe journal of extra-corporeal technology2020

Bivalirudin and Alteplase for Pulmonary Embolism Requiring Veno-Arterial Extracorporeal Membrane Oxygenation in an Adolescent.

Desiree S Machado, Manjiri Tule, Joseph Philip, Tung Wynn, Michael Lazarowicz, Tiago Machuca, Mauricio Pipkin, Hassan Alnuhaimat, Mohammad Ebraheem, Giles Peek and 1 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in The journal of extra-corporeal technology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.3field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 3 citations in OpenAlex.

  1. Vascular and Non-Vascular Intervention in the Pediatric Chest: An Update.Cardiovascular and interventional radiology · 2025
    Review
  2. Review
  3. Academic Perfusion at Its Best and a New Tradition.The journal of extra-corporeal technology · 2020
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Desiree S MachadoDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Manjiri TuleDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Joseph PhilipDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Tung WynnDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Michael LazarowiczDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Tiago MachucaDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Mauricio PipkinDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Hassan AlnuhaimatDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Mohammad EbraheemDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Giles PeekDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
Mark BleiweisDivision of Pediatric Critical Care, Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Congenital Heart Center, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Division of Vascular and Interventional Radiology, Department of Radiology, Department of Cardiothoracic Surgery, and Subdivision of Pulmonology and Advance Lung Failure, Department of Internal Medicine, University of Florida, Gainesville, Florida.
University of Florida · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Saddle pulmonary embolism (PE) remains a challenge to diagnose and manage in pediatric patients. Current literature encourages early consideration of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in high-risk PE patients with impending right ventricular failure. We present a 17-year-old patient who was admitted to a pediatric cardiac intensive care unit with saddle PE requiring emergent VA-ECMO support because of cardiovascular collapse. Despite anticoagulation with bivalirudin and receiving systemic thrombolysis with alteplase, the clot burden was persistent with minimal improvement in right ventricular function. We proceeded to catheter thrombolysis while on VA-ECMO. This ultimately led to a successful resolution of the PE and allowed for weaning off VA-ECMO. PE is rare in children compared with adults, and pediatricians may be unaware of therapies becoming increasingly used in adults such as the use of VA-ECMO, with systemic and local thrombolysis. The concurrent use of a direct thrombin inhibitor for ECMO anticoagulation alongside the thrombolysis is a novel combination in this condition and age-group.

Indexed as

Extracorporeal Membrane OxygenationPulmonary EmbolismAdolescentAdultChildHirudinsHumansPeptide FragmentsRecombinant ProteinsTissue Plasminogen ActivatorbivalirudinHirudinsPeptide FragmentsRecombinant ProteinsTissue Plasminogen Activatoralteplaseanticoagulationbivalirudinchildrendirect thrombin inhibitorpediatricpulmonary embolismthrombolysisveno-arterial extracorporeal membrane oxygenation

Identifiers

PMID33343036
PMCPMC7728497
OpenAlexW3116335471

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.