Why the study?
What proportion of patients with fatal major pulmonary emboli would have been eligible for pulmonary embolectomy?
What proportion of patients with fatal major pulmonary emboli would have been eligible for pulmonary embolectomy?
The feasibility of pulmonary embolectomy is severely limited by the rapid mortality and atypical presentation of major pulmonary emboli, highlighting the need for rapid diagnosis.
Embolectomy eligibility appears rare in fatal PE; leaves open whether prevention or faster diagnostics can reduce mortality in high-risk groups.
Of 101 patients who had major pulmonary emboli confirmed at autopsy, 44 died within 1 hour of the onset of symptoms; 26 had no abrupt change in the clinical course to indicate the presence of emboli; and three died while they were under anesthesia. Of the 28 patients who survived for more than 1 hour after onset of symptoms, seven had incurable malignant lesions, four were unconscious with irreversible brain damage, six were too ill from other diseases to undergo embolectomy, and the diagnosis was not suspected for five. Consequently, of the 101 patients only six would have been selected to undergo pulmonary embolectomy. Only by increasing our diagnostic acumen and by obtaining pulmonary angiograms as soon as possible after onset of symptoms can this salvage rate be improved.
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Gifford et al. (1969) studied this question.
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