Update on Perioperative Pulmonary Embolism Management

Smeltz, Alan M.; Kolarczyk, Lavinia; Isaak, Robert S.

doi:10.1016/j.aan.2017.08.001

Cited by 11 publications

(10 citation statements)

References 40 publications

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“…The collaborative consensus statement by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists recommends TEE in scenarios characterized by persistent, life-threatening circulatory instability, which remains unexplained despite appropriate therapeutic interventions (Class I, Level C evidence) [ 12 , 16 ]. Moreover, studies have provided evidence of comparable levels of sensitivity and specificity between TEE and computed tomography in the evaluation of centrally located PE [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…This approach can rapidly improve RV function while minimizing the risk of intracranial hemorrhage [ 16 ]. MT can be performed through aspiration, fragmentation, or a combination of techniques [ 17 ]. The knowledge regarding catheter-based embolectomy largely stems from registries and combined outcomes of case series, reporting a success rate of 87%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review

Cruz,

Pedroza,

Giraldo

et al. 2023

BMC Anesthesiol

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Background Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE. Methods A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles. Results A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE. Conclusion The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient’s characteristics, is necessary for an optimal approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review

Cruz,

Pedroza,

Giraldo

et al. 2023

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…There are four available therapeutic options for PTE: anticoagulation, thrombolytic therapy, catheterization, and pulmonary artery thrombectomy. 6 – 8 The treatment strategy is selected from among them according to the patient’s circulatory dynamics, respiratory status, and bleeding risk. In addition, current guidelines recommend using VA-ECMO as an aid to circulation in patients with acute-onset PTE and refractory shock in high-risk groups until surgical embolectomy or catheterization is applied.…”

Section: Discussionmentioning

confidence: 99%

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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“…This approach can rapidly improve RV function while minimizing the risk of intracranial hemorrhage [16]. MT can be performed through aspiration, fragmentation, or a combination of techniques [17]. The knowledge regarding catheter-based embolectomy largely stems from registries and combined outcomes of case series, reporting a success rate of 87%.…”

Section: Catheter-directed Therapymentioning

confidence: 99%

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review.

Cruz,

Pedroza,

Giraldo

et al. 2023

Preprint

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Background Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE. Methods A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles. Results A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE. Conclusion The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient's characteristics, is necessary for an optimal approach.

show abstract

Update on Perioperative Pulmonary Embolism Management

Cited by 11 publications

References 40 publications

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review

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

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review.

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