Role of Perioperative Monitoring inDiagnosis of Massive Intraoperative Cardiopulmonary Embolism

Journal of Cardiovascular and Thoracic Research

Leili Pourafkari¹  Nader D. Nader²  Ognjen Visnjevac² 

[1] Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran$$;Departments of Anesthesiology, Critical Care, and Surgery, University at Buffalo, Buffalo, New York, USA$$

关键词: Pulmonary embolism;    intraoperative period;    echocardiography;    pulmonary artery catheter;    end-tidal carbon dioxide;    monitoring;   

DOI  :  10.15171/jcvtr.2014.002

学科分类：农业科学（综合）

来源: Tabriz University of Medical Sciences and Health Services

【 摘 要 】

Purpose:Massivethromboembolic intraoperative pulmonary embolism (IOPE)is rare butcarries agreat degree of morbidity and mortality. This is the first study to formallyassess the utility of various tools for the diagnosis of these events and theimpact of each tool on mortality.Methods:Dueto both the infrequent occurrence of these events and the high mortality ofmassive IOPE, it was cost-prohibitive to prospectively randomize patientpatients to study commonly used diagnostic tools. Hence,a descriptive review ofall reported cases in the literature was performed. This review yielded146cases for past 4 decades. Following a careful review of these cases, thealerting monitor for the occurrence of IOPE was recorded. Furthermore, werecorded the confirming diagnostic tool and the outcome of these patients. Wecompared4 monitoring tools: (1) end-tidal carbon dioxide; (2) central catheterpressures; (3) echocardiography; and (4) standard monitoring of vital signs.Results:Pre-eventuse of transesophageal echocardiographyhad no survival benefit. End-tidalcarbon dioxide changes as an alerting tool were associated with improvedsurvival compared to changes in vital signs (P<0.0001). Signs of right heartstrain were associated with greater mortality, but direct thrombusvisualization was not.Conclusions:Echocardiographyappears to be useful for diagnosis of massive IOPE. Compared with hemodynamiccollapse, end-tidal carbon dioxide decline as the presenting sign of massiveIOPE may be associated with a better prognosis because it may represent earlierdetection of IOPE and allow for more time to intervene.

【 授权许可】

Unknown