Successful Resuscitation Following Intraoperative Acute Pulmonary Embolism With a Focus on Control of Bleeding After Thrombolytic Therapy: A Case Report

Suzuki, Yoshito; Kadoya, Fumito; Nishikawa, Tomoaki; Saya, Hideyuki; Takubo, Kazuko; Nishida, Katsuko

doi:10.1213/xaa.0000000000001549

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Thrombolysis should be considered if circulation cannot be maintained and at facilities where ECMO cannot be used to control circulation immediately. 9 In retrospect, reflecting on our management of this case, we should have conducted an ultrasound of the leg veins or performed contrast-enhanced CT when we observed the elevated D-dimer level after extubation on day 9. Anticoagulation therapy should also have been considered at that time.…”

Section: Discussionmentioning

confidence: 98%

Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation

Kurachi

Ishida

2023

SAGE Open Medical Case Reports

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Acute pulmonary thromboembolism (PTE), which carries a high mortality rate, is difficult to diagnose when it occurs intraoperatively. Therefore, patient prognosis depends on a prompt diagnosis by anesthesiologists. A 49-year-old woman underwent right lower extremity dissection due to a contusion of the right lower extremity caused by trauma. Eleven days after surgery, she underwent debridement for necrosis of the amputation wound. Intraoperatively, a drop in blood pressure and tachycardia were observed, and PTE was suspected based on a rapid deterioration in oxygen saturation and a drop in end-tidal carbon dioxide partial pressure. Transesophageal echocardiography (TEE) showed a thrombus filling the right pulmonary artery, and a diagnosis of PTE was made. The patient was treated using venoarterial extracorporeal membrane oxygenation, and thrombectomy was performed the next day to save her life. In this case, we were able to diagnose and treat the intraoperative acute PTE at an early stage. In addition, the appropriate choice of treatment saved the patient’s life without complications.

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Section: Discussionmentioning

confidence: 98%

Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation

Kurachi

Ishida

2023

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

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Heparin/monteplase/rivaroxaban

2022

Reactions Weekly

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Intraoperative Cardiac Arrest in Orthopaedic Surgery: A Case Series of 42 Patients

Mika,

Ponce,

Wrenn

et al. 2024

J Am Acad Orthop Surg

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Introduction: Intraoperative cardiac arrest (IOCA) is a rare event during orthopaedic surgery. Although infrequent, it has a notable effect, with mortality as high as 35%. Little is known about the outcomes of IOCA in orthopaedic surgery, and this study aims to fill that knowledge gap to improve patient counseling and treatment decisions. Methods: A retrospective review of a single health system over a 20-year period identified 42 patients who experienced IOCA during orthopaedic surgery. Patient characteristics, procedure details, cardiac event specifics, and postoperative complications with an emphasis on morbidity and mortality were collected. Results: Return of spontaneous circulation (ROSC) was achieved in 88% (37 of 42) of patients. In-hospital death following successful resuscitation occurred in 22% (8 of 37) of patients. In those who survived their hospitalization (29 of 42, 69%), 59% (17 of 29) required additional treatment for medical complications acquired secondary to their arrest. IOCA occurred most often during spinal surgery, intramedullary nailing, and cemented endoprosthetic reconstruction, accounting for one-half of cases. Pulmonary embolism was the most common cause of IOCA. In patients requiring case abortion with rapid closure and a delayed return to the operating room for case completion, the infection rate was 40%. Conclusion: The majority of orthopaedic surgery patients achieve ROSC following IOCA. For patients who achieve ROSC, two-thirds had either subsequent in-hospital death or a long-term medical complication secondary to their arrest. These findings suggest that a cautious prognosis is indicated even after a successful resuscitation. Level of Evidence: IV

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Successful Resuscitation Following Intraoperative Acute Pulmonary Embolism With a Focus on Control of Bleeding After Thrombolytic Therapy: A Case Report

Cited by 3 publications

References 15 publications

Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation

Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation

Heparin/monteplase/rivaroxaban

Intraoperative Cardiac Arrest in Orthopaedic Surgery: A Case Series of 42 Patients

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