Surgical Pulmonary Embolectomy and ECMO Support of Massive Pulmonary Embolism: A Case Report and Review of Literatures

Abstract

             Acute pulmonary embolism is one of the life–threatening conditions in medical emergency. The incidence varies from 39 to 115 cases per 100,000 population a year and the mortality rate is seriously high (15–80%) unless the prompt diagnosis and treatment. This is a case report of forty–eight years–old female patient with plump body, who underwent appendectomy, developed shortness of breathing with desaturation on the fifth post–operative day and, eventually had cardiac arrest. After successful cardiopulmonary resuscitation, massive pulmonary embolism was diagnosed, and emergent surgical pulmonary embolectomy was performed with cardiopulmonary bypass at Sakon Nakhon hospital. Right ventricular failure was intra–operatively detected, and the patient was unable to wean from cardiopulmonary bypass. Veno–arterial extracorporeal membrane oxygenator (VA–ECMO) was used for hemodynamic support in 5 consecutive days. This patient survived and was discharged successfully after 26 days of hospitalization. At present, to diagnose and give treatment for this condition, patient’s clinical character, symptoms, history taking, physical examinations and laboratory investigations are critical for evaluating this life–threatening condition. In addition to anticoagulants treatment, surgical pulmonary embolectomy with VA–ECMO support is a life–saving treatment of choice in well–prepared cardiaccenter to increase the survival rate and decrease complication from anticoagulants.             
            Keywords: Acute pulmonary embolism, Surgical pulmonary embolectomy, VA–ECMO implementation