title: Massive pulmonary embolism after application of an Esmarch bandage.
abstract: A 71-yr-old patient who underwent spinal anesthesia for left femoral fracture operation became hypotensive and unconscious after the application of an Esmarch bandage. The transesophageal echocardiography performed during resuscitation revealed pulmonary embolism and acute right ventricular failure. Pulmonary embolectomy with cardiopulmonary bypass was undertaken immediately after the echocardiographic diagnosis. Extracorporeal membrane oxygenation was used after the operation to support the failing right ventricle. The patient was successfully weaned from extracorporeal membrane oxygenation 10 days after the operation. We conclude that transesophageal echocardiography can be very useful in the immediate differential diagnosis of sudden cardiovascular collapse and that extracorporeal membrane oxygenation can be very helpful when acute right ventricular failure follows massive pulmonary embolism.
  
  
  CONCLUSIONS
  Transesophageal echocardiography was highly valuable in finding the cause of sudden intraoperative cardiovascular collapse. The use of extracorporeal membrane oxygenation to support the failing right ventricle after emergent pulmonary embolectomy could help to rescue patients with massive pulmonary embolism.
authors.affiliation: *Department of Anesthesia, Far Eastern Memorial Hospital, Taipei, Taiwan; and Departments of †Surgery and ‡Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chen-Wei
authors.initials: CW
authors.lastname: Lu
authors.forename: Yi-Sharng
authors.initials: YS
authors.lastname: Chen
authors.forename: Ming-Jiuh
authors.initials: MJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000775:Anesthesia, Spinal; D019645:Arthroplasty, Replacement, Knee; D001458:Bandages / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology* / Q000601:surgery; D014111:Tourniquets / Q000009:adverse effects*