Emergent Surgical Embolectomy for Massive Pulmonary Embolism Causing Intraoperative Cardiac Arrest

Abstract

Surgical embolectomy is a viable option for massive PE, and aerosolized epoprostenol can be used as adjuvant treatment for right ventricular strain secondary to acute pulmonary hypertension.

Acute massive pulmonary embolism during patient repositioning following excision of a thymic carcinoma in a patient affected by cryoglobulinemia

“…According to hemodynamic conditions, APE can be classified as (a) submassive, in presence of right ventricular dysfunction with a stable hemodynamic and (b) massive, when severe right ventricular dysfunction leads to an unstable hemodynamic up to severe cardiogenic shock 5 4,5 . Treatment options include systemic anticoagulation, thrombolysis, and surgical embolectomy 3 .…”

“…Treatment options include systemic anticoagulation, thrombolysis, and surgical embolectomy 3 . Despite recent surgery being a contraindication for thrombolysis because of the high risk of bleeding, APE can be a life‐threatening condition and, therefore, in some selected cases, thrombolysis can also be indicated in APE after recent surgery, especially in the thoracic field, with satisfactory results 1,5‐7 . Sakuragi et al 7 reported one case of bleeding out of six patients treated with systemic anticoagulation and/or thrombolysis for pulmonary embolism following pulmonary resection.…”

“…Sakuragi et al 7 reported one case of bleeding out of six patients treated with systemic anticoagulation and/or thrombolysis for pulmonary embolism following pulmonary resection. On the other hand, surgical embolectomy has lost its initial appeal and is, nowadays, limited to severely ill patients in severely‐compromised hemodynamic status as reported by Anyama et al 5 in a patient who sustained an intraoperative cardiac arrest caused by massive APE during surgical fixation of a tibia fracture. Regarding post general thoracic surgery, satisfactory results of a surgical embolectomy on the first POD following lobectomy for lung cancer have been reported by Sakuragi et al 7 Our case is quite peculiar as massive APE still occurred in operative theater, as soon as the patient was shifted from lateral to the supine position.…”