title: Emergency cardiopulmonary bypass for massive pulmonary embolism occurring during nephrectomy.
abstract: We report a case of cardiac arrest secondary to pulmonary tumor embolization occurring in a patient undergoing nephrectomy for renal cell carcinoma with a tumor thrombus invading the inferior vena cava infrahepatically. Tumor embolization in such cases is very rare (1.5%), but if it occurs, mortality is 75%. In our case, resources were rapidly mobilized, and cardiopulmonary bypass was initiated for pulmonary embolectomy within 34 minutes of the cardiac arrest. The patient's trachea was extubated on postoperative day 1, and he was discharged home 9 days later neurologically intact. Excellent preoperative and intraoperative communication among all involved health care providers, as well as rapid mobilization of the available resources, played important roles in the patient's positive outcome.
authors.affiliation: From the *Department of Anesthesia, Critical Care and Pain Medicine, †Department of Urology, and ‡Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karim
authors.initials: K
authors.lastname: Fikry
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Mark
authors.initials: M
authors.lastname: McKeen
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D006323:Heart Arrest / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000503:physiopathology