[Right ventricular assist device (RVAD) in septic, fulminating pulmonary artery embolism]

We describe a 34-year-old male with pulmonary embolism. The patient had been admitted to a peripheral hospital for incision and drainage of a very large ischio-rectal abscess. Four days after successful surgical intervention and during a change of dressings he developed a massive pulmonary artery embolism. The patient was transferred to the Department of Cardiac Surgery in Graz; on arrival he had a cardiac arrest. Resuscitation was initiated and the patient was transferred to the operating theatre where emergency sternotomy and embolectomy revealed large thrombotic masses in the pulmonary circulation. Extracorporeal circulation was initiated, but despite aggressive medical measures (dopamine, dobutamine, isoproterenol, enoximone, and prostaglandin E1 in maximum therapeutic doses) and a long reperfusion time weaning was not possible. Despite the septic state, a right ventricular assist device (RVAD; ABIOMED BVS 5000) was installed. Weaning was finally accomplished with a pump flow of 2.2 l/min m2 and the patient transferred to the intensive care unit. On post-operative day 3 the pump flow was reduced to 2 l/min. The patient's condition remained stable, which made removal of the RVAD possible on postoperative day 5. The further course was uneventful, with secondary ischio-rectal wound closure. His initial psychomotor impairment had nearly disappeared and he was discharged 2 months later.