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Thursday 12 July 2018

Perioperative Pulmonary Embolism Prevention and Treatment

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Massiveperioperative Pulmonary Embolism (PE) is an uncommon event but significant cause of morbidity and mortality. It is estimated that PE is responsible for between 150,000 and 200,000 deaths per year in the United States. 30% of the deaths from PE take place during the perioperative period. PE is the third most common cardiovascular disease after myocardial infarction and cerebrovascular accident (stroke). Several studies have reported mortality rates ranging from 15% to 30%, while mortality rates in a massive PE can reach 30% to 50%. A recent review of more than 3000 massive intraoperative thromboembolic events revealed an overall mortality of 41%.

Surgery increases the risks for perioperative PE. Healthcare providers, including anesthesiologists, are responsible for the diagnosis and treatment of perioperative PE. During surgery, PE often first presents with hemodynamic instability and if progressing quickly, can lead to death. It is important that healthcare providers recognize perioperative PE and know prevention and treatment options. Prompt diagnosis and treatment can save patient lives. In this review, we will focus on perioperative acute PE treatment and prevention.

Diagnosis of a PE in the perioperative period can be a challenge, but early detection can reduce morbidity. The American Heart Association (AHA) classified and defined PE into three classes: massive PE, submassive PE, and low-risk PE. Acute PE with sustained hypotension (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring isotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or Left Ventricular (LV) dysfunction), pulselessness, or persistent profound bradycardia (heart rate<40 bpm with signs or symptoms of shock).

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