Abstract
Study design
Case report.
Purpose
The purpose of this case report is to illustrate the utility of ECMO as possible treatment in the management of perioperative massive pulmonary embolism (PE) during spine surgery. We present a case report of an intra-operative massive PE managed with ECMO and review relevant literature of perioperative massive PE. Treatment poses substantial risk given the need for anticoagulation. ECMO has not previously been described in the management of this condition in spine surgery.
Methods
The patient is a 75-year-old male with hypertension, diabetes mellitus type II, chronic obstructive pulmonary disease, and prior cerebral infarction with minimal residual deficits who presented for Lumbar 2–Sacral 1 (L2–S1) revision posterior spinal decompression and fusion with L3–4 TLIF (Transforaminal Lumbar Interbody Fusion). The operation was routine until removing him from the operative table when he suffered a massive pulmonary embolism.
Results
The patient became extremely unstable hemodynamically requiring massive doses of three vasopressors. He was too unstable for additional imaging or to transport for mechanical thrombectomy so with the guidance of our cardiologist we initiated ECMO. The patient ultimately recovered well and was discharged from the hospital at his neurological baseline and preserved cardiac function.
Conclusion
ECMO is a viable option for management of acute perioperative massive pulmonary embolism when less invasive treatments are not sufficient.
Level of evidence
5.
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Data availability
Authors can confirm that all relevant data are included in the article and/or its supplementary information files.
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No funds were received in support of this work. No relevant financial activities outside the submitted work. The collection and evaluation of all protected patient health information was Health Insurance Portability and Accountability Act-compliant.
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JW: Designed the framework, gathered data, wrote, and edited the manuscript. Agrees to be accountable for the integrity of this manuscript and approves of this version for publication. DT: Wrote, and edited a significant portion of the revisions of the major changes of the manuscript. Agrees to be accountable for the integrity of this manuscript and approves of this version for publication. AM: Gathered data, literature review, wrote, and edited the manuscript. Agrees to be accountable for the integrity of this manuscript and approves of this version for publication. JCQ: Designed the framework, gathered data, and edited the manuscript. Agrees to be accountable for the integrity of this manuscript and approves of this version for publication.
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Withrow, J., Trimble, D., Medina, A. et al. Intraoperative massive pulmonary embolism during revision lumbar fusion managed with extracorporeal membrane oxygenation. Spine Deform 11, 753–757 (2023). https://doi.org/10.1007/s43390-022-00632-3
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DOI: https://doi.org/10.1007/s43390-022-00632-3