Treatment of Acute Massive/Submassive Pulmonary Embolism

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Thirty-five consecutive patients with massive and submassive pulmonary embolism (PE) were reviewed. In 75% of these cases, PE could be suspected on the basis of electrocardiogram alone. Echocardiography was quite useful for diagnosing PB and assessing right ventricle after-load at the bedside. Spiral computer tomography was effective for obtaining a definitive diagnosis even in a relatively hemodynamically unstable patient. Thrombolysis therapy was given to 30 cases and was apparently effective in 17 cases (17/30, 56.7%). Percutaneous cardiopulmonary support (PCPS) was needed for 7 severe cases. Seven patients, including 5 of the PCPS recipients, underwent surgical embolectomy. Overall mortality was 28.6% (10/35), and surgical mortality was 28.6% (2/7). The significant predictors for mortality were systolic blood pressure <100 mmHg, dopamine>5 μg・kg^<-1>・min^<-1>・pH <7.4, PaCO_2>40 torr, base excesss <-5 mmol/L, urine output <0.8 ml・kg^<-1>・h^<-1>, intubation, cardiopulmonary resuscitation, duration from attack to emergency room >5h, shock duration >4 h, aspartate aminotransferase >100 U/L, alanine aminotransferase >100 U/L and lactate dehydrogenase >600 U/L. Predictors of surgical intervention were dopamine >51μg・kg^<-1>・min^<-1>, shock duration >4h and PCPS. Early initiation of thombolysis therapy is recommended, except in case where it is absolutely contraindicated. Because it is difficult in the early phase of PB to make a decision to perform surgery, aggressive application of PCPS is recommended for the cardiogenic shock associated with massive PB.
社団法人日本循環器学会の論文
2002-04-20

Treatment of Acute Massive/Submassive Pulmonary Embolism

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