Survival following massive pulmonary hemorrhage complicating pulmonary embolectomy: a case report

Continued employment of extracorporeal circulation provides for adequate oxygenation despite massive pulmonary hemorrhage. However, this modality requires continuing heparinization, which seems to preclude control of the hemorrhage. The longer bleeding persists, the more the pulmonary damage. Further, the problems of massive volume replacement will be added to this catastrophe. The authors believe that rapid discontinuance of extracorporeal bypass, reversal of heparinization with protamine, aggressive pulmonary suctioning, and alternate ventilation with 100% O2 were responsible for their good result. Arterial hypoxemia was avoided despite pulmonary suction yielding 1500 ml in 17 minutes.