Survival from catastrophic intraoperative pulmonary embolism.

Abstract

I? ulmonary embolism (PE) causes approximately 200,000 deaths in the United States (1). Each year, more than 650,000 patients have symptoms of PE (2) and two-thirds of those who survive the initial event will be improperly diagnosed. In fact, 15%-20% of all in-hospital deaths can be attributed to PE (3,4). Although rare, sudden intraoperative cardiac arrest can occur without preceding signs or predisposing clinical conditions. The etiologies of sudden cardiovascular collapse include intraoperative myocardial infarction, anaphylactic reaction, anesthetic overdose, and massive pulmonary embolism (5,6). We report a patient who sustained a massive catastrophic PE while undergoing surgery for repair of a femoral hernia. Transesophageal echocardiography (TEE) provided an immediate diagnosis of the patient’s sudden cardiovascular collapse, allowing appropriate thrombolytic therapy to dissolve the thrombus and reestablish normal ventricular function.