Interv Akut Kardiol. 2008;7(1):31-34

Traumatologic patient with severe haemorrhagic shock hospitalized at cardiac surgery for massive pulmonary embolism

Ondřej Žuščich², Ivo Fluger², Roman Hájek^1,2

¹ Interní hematoonkologická klinika LF MU a FN Brno

² Kardiochirurgická klinika FN a LF UP v Olomouci

Introduction: Pulmonary embolism belongs to leading causes of death from cardiovascular mortality. A particularly important place has a massive pulmonary artery embolism with collapse of circulation and indication to surgical thrombectomy. The case report discusses variable etiology and combination of risk factors.

Case report: A thirty year old female patient after a fall from bicycle with posttraumatic rupture of the liver, massive hemotherapy, disseminated intravascular coagulation, brain edema, complicated by massive pulmonary embolism with circulation failure. A surgical thrombectomy was performed with evacuation of multiple thrombotic masses.

Results: A patient with unfavorable prognosis (significant blood losses, disseminated intravascular coagulation, brain edema, resuscitation, massive pulmonary embolism) was discharged home after 16 days. Studies show possible good results of surgical thrombectomy in cases of early and suitable indications. Boston study presents 47 operated patients, from whom 3 patients died (6 %), 2 with preoperative cardiac arrest. 12 patients (26 %) were in cardiogenic shock before surgery, 6 patients (11 %) had cardiac arrest. The study shows the indications for the trombectomy and its outcomes. The average length of therapy was 11 days (3–75 days). One year and 3 year survival was 86 % and 83 %, respectively.

Conclusion: A successful outcome, a return of the patient to an active life, was possible thanks to multidisciplinary approach, good initial care and appropriate indication to surgical thrombectomy in a specialized department.

Keywords: pulmonary embolism, surgical thrombectomy, multidisciplinary approach

Published: March 27, 2008  Show citation