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Catheter-induced pulmonary artery rupture in the setting of cardiopulmonary bypass

1993; Elsevier BV; Volume: 56; Issue: 3 Linguagem: Inglês

10.1016/0003-4975(93)90912-2

1552-6259

John D. Urschel, P. David Myerowitz,

Ultrasound in Clinical Applications

Pulmonary artery rupture is an infrequent complication of flow-directed catheters.Because cardiopulmonary bypass offers an opportunity for control of gas exchange and hemorrhage, pulmonary artery rupture in this setting is different from that occurring in the intensive care unit and catheterization laboratory.A collective review of 30 published cases was conducted.Sixty-nine percent of patients were female and 50% had valvular heart disease.The right pulmonary artery was injured in 93% of cases.Arterial rupture presented with airway hemorrhage in 29 of 30 patients.Six patients presented with a herald airway bleed after catheter insertion but before operation.Three of 4 patients died when operation was performed in the face of a herald bleed.Airway hemorulmonary artery rupture is an infrequent complication P of flow-directed pulmonary artery catheters.Maintenance of respiratory gas exchange and arrest of hemorrhage are the immediate goals of treatment.In the setting of cardiopulmonary bypass, a unique opportunity exists for provision of gas exchange and control of hemorrhage.Despite this, mortality from catheter-induced pulmonary artery rupture during cardiac operations is very high.Extrapolation of management strategies from the intensive care unit to the operating room is not appropriate.The need for a rational approach to catheter-induced pulmonary artery rupture in the setting of cardiopulmonary bypass prompted us to review the literature and formulate treatment recommendations. Material and MethodsThe English-language medical literature was searched by Medline and manual methods to retrieve all published reports of catheter-induced pulmonary artery rupture occurring in the setting of cardiopulmonary bypass.Cases were excluded if pulmonary artery injury occurred before the patient was brought to the operating room or if the first manifestation of arterial injury was seen after transfer out of the theater.Pulmonary artery embolectomies were not included.Fisher's exact test (two-sided) was used to assess the relationship between patient variables and outcome.