Surgical Management of Massive Pulmonary Embolism Presenting with Cardiopulmonary Arrest: How Far Is Too Far?

ABSTRACT The incidence of diagnosed massive pulmonary embolism presenting to the Emergency Department is between 3% and 4.5% and it is associated with high mortality if not intervened timely. Cardiopulmonary arrest in this subset of patients carries a very poor prognosis, and various treating pathways have been applied with modest rate of success. Systemic thrombolysis is an established first line of treatment, but surgeons are often involved in the decision-making because of the improving surgical pulmonary embolectomy outcomes.

摘要 急诊科接诊的确诊大块肺栓塞（massive pulmonary embolism）病例，其发病率介于3%至4.5%之间；若未及时干预，患者的死亡率较高。此类患者若出现心搏骤停，预后极差。目前已应用多种治疗路径，但仅能取得有限的治疗效果。系统性溶栓（systemic thrombolysis）是已确立的一线治疗方案，但随着外科肺动脉栓子切除术（pulmonary embolectomy）的治疗效果不断改善，外科医师常参与此类病例的治疗决策制定。