The first experience of treatment applied to patients with pulmonary embolism that developed on the COVID-19 background

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course.Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO 2 below 85%, РаО 2 — below 76 mm Hg, Borg index > 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases.Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO 2 came back to the initial values and was in the range 93–96% and RaO 2 — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.