Treatment of Acute Massive/Submassive Pulmonary Embolism.
2002; Japanese Circulation Society; Volume: 66; Issue: 5 Linguagem: Inglês
10.1253/circj.66.479
ISSN1347-4820
AutoresEiki Tayama, Masanao Ouchida, Hideki Teshima, Tohru Takaseya, Ryouichi Hiratsuka, Koji Akasu, Nobuhiko Hayashida, Shuji Fukunaga, Hidetoshi Akashi, Takemi Kawara, Shigeaki Aoyagi,
Tópico(s)Heparin-Induced Thrombocytopenia and Thrombosis
ResumoThirty-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 PE 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 5 microg x kg(-1) min(-1), pH 40 torr, base excesss <-5 mmol/L, urine output 5h, shock duration >4h, aspartate aminotransferase >100U/L, alanine aminotransferase >100U/L and lactate dehydrogenase >600U/L. Predictors of surgical intervention were dopamine >5 microg x 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 PE to make a decision to perform surgery, aggressive application of PCPS is recommended for the cardiogenic shock associated with massive PE.
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