Emergency Pulmonary Embolectomy for Massive Pulmonary Embolism

Emergency pulmonary embolectomy (EPE) was done in 17 patients who suffered massive pulmonary embolism (MPE). The indications for emergency intervention were refractory hypotension or cardiac arrest. MPE occurred from 1 to 27 days after operation in 11 patients. Five had elective procedures, and six were recuperating from surgery for trauma. Three patients were under heparin therapy for either thrombophlebits or previous pulmonary infarction. Debilitating disease accounted for the occurrence of MPE in the remaining three patients. Because of the urgency hypoxemia not responsive to 100% oxygen inhalation, elevated central venous pressure, and electrocardiographic abnormalities suggestive of right heart strain prompted pulmonary arteriograms in 11 of 17 patients. The remaining patients underwent exploration without arteriograms either because of refractory cardiac arrest earlier in the series or because the capability for emergency pulmonary arteriograms was not present. Six of the 17 patients (35%) expired following EPE. Prolonged hypoxemia prior to initiation of cardiopulmonary bypass was the cause of death in five of the six patients. The remaining patient had multiple small pulmonary emboli and did not respond to EPE. On analysis of the factors causing mortality, a method of management of MPE has been suggested. Early initiation of portable cardiopulmonary bypass and X-ray diagnostic procedures under cardiopulmonary bypass if necessary are essential techniques for improved survival. Despite recent advances in cardiovascular surgery, MPE remains a particular challenge.