Pulmonary embolectomy.

During the past 10 years, 20 patients at St. Thomas Hospital had pulmonary embolectomy; there were 12 survivors. Ten patients had a pulmonary arteriogram prior to operation and, of these, there were 7 survivors. The remaining 10 patients were seen with circulatory collapse and were taken immediately to the operating room without definitive diagnostic studies. Ten patients were undergoing cardiopulmonary resuscitation at the time of the embolectomy and, of these, there were 5 long-term survivors. This review indicates that immediate diagnostic studies, such as lung scan or pulmonary arteriogram, should be undertaken as soon as the diagnosis of pulmonary embolus is entertained. Patients with sudden collapse, in the appropriate clinical setting, should be transported to the operating room as soon as possible. It would also appear that patients who are unresponsive to the usual measures of cardiopulmonary resuscitation are still reasonable candidates for pulmonary embolectomy, and this may represent their only change for survival. Patients in whom massive pulmonary embolus is confirmed by angiography should be considered for early pulmonary embolectomy despite a relatively stable hemodynamic and clinical picture.