Submitted: 15 Sep 2014
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - Firefox Plugin)

J Cardiovasc Thorac Res. 2014;6(3): 141-145.
doi: 10.15171/jcvtr.2014.002
PMID: 25320660
PMCID: PMC4195963
  Abstract View: 1268
  PDF Download: 1242

Review Article

Role of Perioperative Monitoring in Diagnosis of Massive Intraoperative Cardiopulmonary Embolism

Ognjen Visnjevac 1, Leili Pourafkari 2, Nader D. Nader 1*

1 Departments of Anesthesiology, Critical Care, and Surgery, University at Buffalo, Buffalo, New York, USA
2 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Departments of Anesthesiology, Critical Care, and Surgery, University at Buffalo, Buffalo, New York, USA nnader@buffalo.edu


Purpose:Massive thromboembolic intraoperative pulmonary embolism (IOPE)is rare butcarries a great degree of morbidity and mortality. This is the first study to formally assess the utility of various tools for the diagnosis of these events and the impact of each tool on mortality. Methods:Due to both the infrequent occurrence of these events and the high mortality of massive IOPE, it was cost-prohibitive to prospectively randomize patient patients to study commonly used diagnostic tools. Hence,a descriptive review of all reported cases in the literature was performed. This review yielded146 cases for past 4 decades. Following a careful review of these cases, the alerting monitor for the occurrence of IOPE was recorded. Furthermore, we recorded the confirming diagnostic tool and the outcome of these patients. We compared4 monitoring tools: (1) end-tidal carbon dioxide; (2) central catheter pressures; (3) echocardiography; and (4) standard monitoring of vital signs. Results:Pre-event use of transesophageal echocardiographyhad no survival benefit. End-tidal carbon dioxide changes as an alerting tool were associated with improved survival compared to changes in vital signs (P<0.0001). Signs of right heart strain were associated with greater mortality, but direct thrombus visualization was not. Conclusions:Echocardiography appears to be useful for diagnosis of massive IOPE. Compared with hemodynamic collapse, end-tidal carbon dioxide decline as the presenting sign of massive IOPE may be associated with a better prognosis because it may represent earlier detection of IOPE and allow for more time to intervene.
Keywords: Pulmonary embolism, intraoperative period, echocardiography, pulmonary artery catheter, end-tidal carbon dioxide, monitoring
First Name
Last Name
Email Address
Security code

Abstract View: 1268

Your browser does not support the canvas element.

PDF Download: 1242

Your browser does not support the canvas element.