The urgent pulmonary embolectomy: Mechanical resuscitation in the operating theatre determines the outcome

Background: The urgent pulmonary embolectomy as a surgical treatment of acute massive pulmonary embolism (PE) is still the subject of controversial discussion regarding indication, operative technique, and prognosis. Methods: From 10/89 to 9/97 40 patients underwent urgent exploration of the pulmonary artery with the aid of extracorporeal circulation (ECC). Results: The overall operative mortality was 35%. Univariate and multivariate logistic regression analysis showed preoperative hemodynamics and cardiopulmonary resuscitation (CPR) as the most important predictive factors for outcome: mortality rate was significantly higher after CPR (=63%) than without CPR (=10%) (p = 0.001). Other factors such as immobility, overweight, and concomitant cardiopulmonary disease also had an influence on the postoperative outcome. Conclusions: Pulmonary embolectomy (on the beating heart with ECC under total bypass) under stable hemodynamics, without CPR however, still constitutes an important form of treatment of acute massive PE with excellent long-term results.