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Hemodynamic instability in patients undergoing pulmonary embolectomy: institutional experience
Jeremy M Bennett1, Mias Pretorius1, Rashid M Ahmad2
1Department of Anesthesiology Vanderbilt University Medical Center, Nashville, TN 37232.
Journal of Clinical Anesthesia
|December 30, 2014
Summary
Emergent pulmonary embolectomy for cardiac surgery patients can lead to instability. Some patients required cardiopulmonary bypass after induction or during surgery, with one death reported.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Acute pulmonary embolism (PE) poses significant risks in emergent cardiac surgery.
- Surgical pulmonary embolectomy is reserved for refractory cases or cardiogenic shock.
- Institutional experience suggests improved outcomes with surgical embolectomy.
Purpose of the Study:
- To retrospectively analyze outcomes of patients undergoing surgical pulmonary embolectomy.
- To evaluate anesthetic management and identify risks for hemodynamic instability.
Main Methods:
- Retrospective review of 40 patients undergoing emergent pulmonary embolectomy (2008-2012).
- Chart review of anesthetic records, echocardiography, and surgical reports.
- Assessment of cardiac function, need for emergent cardiopulmonary bypass, and morbidity.
Main Results:
- 12.5% of patients experienced hemodynamic instability requiring emergent cardiopulmonary bypass post-induction.
- 17% developed instability during pericardial manipulation, a previously unreported finding.
- One in-hospital mortality occurred; higher induction drug doses were noted in patients needing bypass post-induction.
Conclusions:
- Emergent cardiopulmonary bypass may be required during different stages of pulmonary embolectomy.
- No specific risk factors identified for instability during pericardial manipulation in initially stable patients.
- Anesthetic management requires careful consideration due to potential for hemodynamic compromise.
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