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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