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Anesth Analg 2004;98:1187-1189
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000104583.77388.02

GENERAL ARTICLES

Massive Pulmonary Embolism After Application of an Esmarch Bandage

Chen-Wei Lu, MD*, Yi-Sharng Chen, MD{dagger}, and Ming-Jiuh Wang, MD, PhD{ddagger}

*Department of Anesthesia, Far Eastern Memorial Hospital, Taipei, Taiwan; and Departments of {dagger}Surgery and {ddagger}Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Address correspondence and reprint requests to Ming-Jiuh Wang, MD, PhD, Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan South Rd., Taipei, Taiwan 100. Address e-mail to canon{at}ha.mc.ntu.edu.tw

A 71-yr-old patient who underwent spinal anesthesia for left femoral fracture operation became hypotensive and unconscious after the application of an Esmarch bandage. The transesophageal echocardiography performed during resuscitation revealed pulmonary embolism and acute right ventricular failure. Pulmonary embolectomy with cardiopulmonary bypass was undertaken immediately after the echocardiographic diagnosis. Extracorporeal membrane oxygenation was used after the operation to support the failing right ventricle. The patient was successfully weaned from extracorporeal membrane oxygenation 10 days after the operation. We conclude that transesophageal echocardiography can be very useful in the immediate differential diagnosis of sudden cardiovascular collapse and that extracorporeal membrane oxygenation can be very helpful when acute right ventricular failure follows massive pulmonary embolism.

IMPLICATIONS: Transesophageal echocardiography was highly valuable in finding the cause of sudden intraoperative cardiovascular collapse. The use of extracorporeal membrane oxygenation to support the failing right ventricle after emergent pulmonary embolectomy could help to rescue patients with massive pulmonary embolism.




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P. Rosenberger, S. K. Shernan, T. Weissmuller, H. K. Eltzschig, C.-W. Lu, Y.-S. Chen, and M.-J. Wang
Role of Intraoperative Transesophageal Echocardiography for Diagnosing and Managing Pulmonary Embolism in the Perioperative Period * Response
Anesth. Analg., January 1, 2005; 100(1): 292 - 293.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.