Emergency Pulmonary Embolectomy after Failed Thrombolysis in a Community Hospital: A Choice of Institutional Preference?

Abstract

Major pulmonary embolism (MPE), defined as a large central PE with hemodynamic instability, has been shown to carry a crude mortality rate of 17.4-28%.1, 2 Despite this high mortality rate, the treatment of major PE has not been well-standardized and remains controversial. Surgical embolectomy, once viewed as a procedure of last effort, has recently become incorporated into the pulmonary embolism algorithm of some tertiary medical centers.3, 4, 5 However, this procedure, to our knowledge, has not yet been reported in a community hospital. We present a successful case of pulmonary embolectomy for a major pulmonary embolism performed at a community hospital, review of the literature, and propose an algorithm for the treatment of a major pulmonary embolism. Work was done at Memorial Hospital, South Bend, IN.