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

Background: The urgent pulmonary embolectomy as a surgical treatment of acu te massive pulmonary embolism (PE) is still the subject of controversial di scussion regarding indication, operative technique, and prognosis. Methods: From 10/89 to 9/97 40 patients underwent urgent exploration of the pulmona ry artery with the aid of extracorporeal circulation (ECC). Results: The ov erall operative mortality was 35%. Univariate and multivariate logistic reg ression analysis showed preoperative hemodynamics and cardiopulmonary resus citation (CPR) as the most important predictive factors for outcome: mortal ity 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 to tal bypass) under stable hemodynamics, without CPR however, still constitut es an important form of treatment of acute massive PE with excellent long-t erm results.