[Pulmonary embolectomy using extracorporeal circulation. An anesthesiological and intensive care viewpoint (author's...

Three cases of massive pulmonary embolism are described in order to illustrate the indications for open pulmonary embolectomy with temporary cardiopulmonary bypass. Surgical treatment is mandatory in the presence of shock with systemic arterial hypotension below 90 mm Hg, arterial hypoxaemia more than 50 per cent as demonstrated by pulmonary arteriography, and pulmonary mean pressure exceeding 30 mm Hg. Additionally the prognosis of the underlying disease should be considered. The specific problems related to anesthesia are associated with the severe shock and its concomitant excessive acid base disturbances both of them being refractory to medical treatment.