Acute massive pulmonary embolism with cardiopulmonary resuscitation: management and results.
Patients who experience hemodynamic collapse after acute massive pulmonary embolism have a poor prognosis. Herein, we report our results with 8 patients and discuss a surgical strategy that can improve perioperative survival. From August 1994 through May 2005, 8 consecutive patients (6 women, 2 men; age range, 27-68 yr) were urgently referred to our unit after experiencing hemodynamic collapse. All required cardiopulmonary resuscitation. Seven patients underwent pulmonary embolectomy. One patient was successfully treated with thrombolytic therapy alone under continuous monitoring by the surgical team. There were 2 intraoperative deaths (30-day mortality rate, 28.5%). One survivor required a right ventricular assist device. Follow-up of the patients ranged from 8 months to 8 years. One patient died 8 months after the pulmonary embolectomy from long-term complications of cerebral damage that had occurred during preoperative resuscitation. We conclude that prompt surgical management improves the early survival rates of patients who require cardiopulmonary resuscitation subsequent to massive pulmonary embolism.
Konstantinov
Igor E
IE
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, WA 6009, Australia. igorkonst@hotmail.com
Saxena
Pankaj
P
Koniuszko
Miriam D
MD
Alvarez
John
J
Newman
Mark A J
MA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001315:Australia; D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation; D017128:Embolectomy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D016306:Vena Cava Filters; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
D005343:Fibrinolytic Agents; D006493:Heparin