Abstract
We report an orthopedic patient who survived a fatal pulmonary embolism (PE) during pelvic surgery. Reconstruction of pelvic fracture was scheduled for a 59-year-old man following 10 days of pelvic traction after a traffic accident. The values for SpO2, end-tidal carbon dioxide (EtCO2), and systolic blood pressure suddenly decreased when massive bleeding occurred due to vascular injury during the surgery. Arterial blood gas analysis demonstrated a low value of PaO2 and a discrepancy between EtCO2 and PaCO2 values. The occurrence of PE was suspected based on both the results of arterial blood gas analysis and distension of the right heart detected by transesophageal echocardiography. Percutaneous cardiopulmonary support (PCPS) was immediately introduced due to unstable hemodynamics and unresolved hypoxia. Surgical thrombectomy for PE was performed with cardiopulmonary bypass two days after the first procedure because of persistent hemodynamic and respiratory failure. PCPS was successfully removed three days after the pulmonary thrombectomy. A temporary inferior vena cava filter was placed for the prevention of PE due to residual deep vein thrombosis before rehabilitation proceeded. The patient was discharged without any complications following the completion of rehabilitation. Conclusion: The decision to introduce PCPS and surgical treatment should be made without delay for a critically ill patient with PE.
