Intraoperative Catastrophic Acute Pulmonary Embolism: A Case Report

Area of Science:

• Cardiovascular Medicine
• Surgical Oncology
• Critical Care Medicine

Background:

• A 75-year-old female with a history of recurrent sigmoid stricture, atrial fibrillation, hypertension, hyperlipidemia, peripheral vascular disease, and chronic kidney disease presented for elective sigmoidectomy.
• The patient had a significant smoking history and multiple vascular interventions, including bilateral iliac and renal artery stenting.

Observation:

• During anesthetic induction for sigmoidectomy, the patient developed pulseless ventricular tachycardia, necessitating immediate resuscitation.
• Intraoperative findings included biventricular failure and a right pulmonary artery clot.

Findings:

• Despite extensive resuscitative efforts and initiation of veno-arterial extracorporeal membrane oxygenation (VA ECMO), the patient's condition rapidly deteriorated.
• The patient ultimately required withdrawal of life support due to refractory cardiovascular collapse.

Implications:

• This case underscores the significant risks associated with elective surgery in patients with extensive comorbidities and complex vascular disease.
• It highlights the critical importance of a multidisciplinary approach and thorough preoperative optimization for high-risk surgical candidates.
• The case emphasizes the limitations of even advanced life support measures in the face of severe, multi-organ system failure during complex procedures.