Key result
Intraoperative cardiac arrest from high-risk pulmonary embolism carries ~75% mortality.
Why the study?
Limited studies have focused on the optimal treatment choice for intraoperative cardiac arrest secondary to high-risk pulmonary embolism during major non-cardiac surgeries.
Observational (n=8)
No
Intraoperative cardiac arrest due to high-risk pulmonary embolism is highly lethal, emphasizing the need for swift multidisciplinary intervention and primary reperfusion therapy, such as systemic thrombolysis or mechanical thrombectomy.
Signals dire prognosis for intraoperative high-risk PE arrest; leaves open prospective validation of algorithmic interventions.
BACKGROUND: Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE. METHODS: A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles. RESULTS: A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE. CONCLUSION: The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient's characteristics, is necessary for an optimal approach.
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Cruz et al. (2023) conducted an observational in Intraoperative pulmonary embolism with cardiac arrest (n=8). Primary perfusion interventions (thrombolysis, thrombectomy, anticoagulation) and hemodynamic support was evaluated on Mortality. In a retrospective series of 8 patients experiencing intraoperative cardiac arrest secondary to high-risk pulmonary embolism, the overall mortality rate was 75%.
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