Beall Jr., Arthur C.; Cooley, Denton A.
November 1965
Angiology;Nov1965, Vol. 16 Issue 11, p637
Academic Journal
Use of cardiopulmonary bypass for embolectomy has been shown to be an effective procedure in patients with otherwise fatal acute massive pulmonary embolism. Partial bypass cannulating the femoral vein and femoral artery under local anesthesia has been found helpful in resuscitation of these patients prior to definitive embolectomy. Availability of portable pumping equipment and disposable plastic oxygenator, which can be primed with 5 per cent dextrose in distilled water, now allows immediate application of such techniques under emergency circumstances. Indications for pulmonary embolectomy have not been entirely standardized, although certain guidelines are available. Definitive diagnosis is mandatory and is best established by selective pulmonary angiography. The need for vasopressors to maintain systemic arterial pressure at acceptable levels, except perhaps for a few minutes immediately following embolism, is probably the best indication for emergency embolectomy. Degree of embolism and right heart hemodynamics may be helpful on occasions, while at other times they may be misleading. Final decision as to management of the patient with acute massive pulmonary embolism, therefore, must be based on a combination of factors, and each case must be decided individually.


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