Emergent Pulmonary Embolectomy: The Efficacy of Percutaneous Cardiopulmonary Support as a Bridge to Surgery

Summary

Five patients with acute pulmonary embolism (APE) underwent operation by the author between 1985 and 1990 because of circulatory collapse. All were weaned from extracorporeal circulation, but two patients were lost because of bleeding tendency and neurological deficit. Considering such experiences until 1990, we have changed our strategy in the surgical management of APE at our institution. Since 1991, 33 patients with massive APE have been treated, most with thrombolytic therapy. Transthoratic echocardiogram is very effective in detecting APE as an initial diagnostic procedure and confirmed marked dilation of the right ventricle with a small left ventricle. Four patients were seen with severe cardiopulmonary collapse, and all received cardiopulmonary resuscitation. Acute pulmonary embolism was strongly suspected, and percutaneous cardiopulmonary support (PCPS) was initiated for resuscitation and the maintenance of circulation for three patients. After resuscitation, trans-esophageal echocardiography was done and showed thrombus in the main pulmonary artery. Three patients were taken to the operating room without the conventional definitive diagnostic studies. One patient responded to resuscitation without PCPS, underwent pulmonary angiography, and received thrombolytic therapy followed by emergent pulmonary embolectomy. All four patients were subsequently discharged from the hospital and are doing well now. The clinical course of the four patients is described, and management of massive pulmonary embolism and the efficacy of PCPS as a bridge to operation are discussed. It is concluded that surgical treatment for moribund APE is effective and can be performed safely, and PCPS is also effective as a bridge to operation or alternative diagnostic procedure or treatment.