Pulmonary embolism: a frequent cause of acute fatality after lung resection

Abstract

Between 1975 and 1993, lung resections were performed in 1735 patients because of malignancies, with an early postoperative mortality of 7.2% (125 patients). Early postoperatively acute cardiorespiratory failure was experienced by 32 patients (1.85%), of whom 26 died despite immediate resuscitation measures. In 20/26 patients autopsy was performed revealing central pulmonary embolism as the cause of death in 19 of them. In one patient a rupture of the free posterior left ventricular wall following transmural myocardial infarction was found. Two patients who could be resuscitated successfully were operated on with extracorporeal circulation after pulmonary angiography had been performed to confirm the diagnosis; however they died 2 days later of right heart failure. Of the survivors three cases had myocardial infarctions, one patient had arrhythmias of unknown etiology. Immediate embolectomy with the use of extracorporeal circulation was performed in two patients, only on the ground of suspected pulmonary embolism and without further diagnostic measures. Both patients survived. Of the 23 cases, with proven pulmonary embolism 17 were still under postoperative prophylaxis with heparin. Six patients were already fully mobilized. We conclude that massive pulmonary embolism is a frequent early postoperative fatal complication after lung resections, which cannot be safely prevented by postoperative heparinization. The only successful life-saving measure in the case of central pulmonary embolism is immediate pulmonary embolectomy, if necessary without further diagnostic measures.

Prevention of VTE in Nonorthopedic Surgical Patients

“…In another analysis of 1,735 lung resections for malignancy, autopsy-confi rmed fatal PE occurred in 1.2% of patients, despite ongoing heparin prophylaxis in most of them. 138 Another study of 706 thoracic surgery patients reported objectively confi rmed PE in 20 of 344 (7%) patients who did not receive prophylaxis, but there were no episodes of PE among 362 patients who wore IPC. 139 Finally, the 91-day risk of clinically detected VTE for almost 13,000 patients undergoing major lung resection for malignant disease was 1.6% in the California Patient Discharge Data Set.…”

Case of acute pulmonary embolism in post pneumonectomy-a rare clinical presentation and management

“…Pulmonary embolism has been found to be a worthy cause of acute fatality after lung resection with 1.85% of patients in one study dying of acute cardiorespiratory failure, the majority because of pulmonary embolus. 12 Surgical resection reduces respiratory reserve and the ability to tolerate venous thromboembolism. Patients with pneumonectomy represent the highest risk category because their respiratory reserve is most compromised and their increased pulmonary artery pressures and decreased pulmonary vascular bed leave little margin to tolerate venous thromboembolism.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…In the study performed by Dentali et al on 693 patients, who underwent thoracotomy due to lung cancer, despite the routine use of prophylaxis with LMWH or LDUH, symptomatic VTE was diagnosed in 1.7% of patients, including pulmonary embolism in 1.3% of patients, and fatal pulmonary embolism in 0.6% [98]. Kalweit et al in the study evaluating the results of treatment of 1735 patients, who underwent oncological lung resections, fatal pulmonary embolism was diagnosed post mortem in 1.2% of patients (despite the use of thromboprophylaxis in the majority of the studied population) [99]. Similar data was obtained in another retrospective analysis, in which the risk of clinically symptomatic VTE within 3 months in 13 000 patients undergoing major lung resections due to cancer amounted to 1.6% [100].…”