Acute and Critical Care

Unexpected Intra-operative Pulmonary Thromboemolism during Elective Mastoidectomy: A Case Report: Hyun Jeong Kwak, Hee Yeon Park, Hong Soon Kim, Sung Ho Choi, Kyung Cheon Lee; Korean J Crit Care Med. 2009;24(3):160-163.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.160

Abstract PDF: We report on a 45-year-old patient who sustained an intra-operative pulmonary thromboembolism during elective mastoidectomy under general anesthesia. At the end of surgery, the patient developed hemodynamic compromise and exhibited T wave inversion on electrocardiogram. Echocardiography showed an echogenic mass in the right pulmonary artery and pulmonary hypertension. Pulmonary thromboembolism is rare in the field of otolaryngology and head and neck surgery; however, it may develop, resulting in a fatal outcome. It is thus important to establish the diagnosis early and prevent such serious complications.

Management of Pulmonary Thromboembolism with Inferior Vena Cava Filter: A Case Report: Yeon Jang, Yun Sun Chin, Hyun Suk Jung, Ho Kyung Song; Korean J Crit Care Med. 2008;23(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.111

Abstract PDF: We managed a case in which an inferior vena cava filter was inserted for a pulmonary thromboembolism that occurred during general anesthesia. A 71-year-old woman was prepped for reduction of a distal femur fracture and arthroplastic surgery. Her initial vital signs were stable, but the end-tidal CO2 and SaO2 were decreased gradually after application of the tourniquet for surgery. Because of impaired ventricular wall motion and a dilated inferior vena cava on echocardiogram, we suspected a pulmonary thromboembolism. Thus, we inserted an inferior vena cava filter percutaneously under propofol sedation in the Radiology Department. In addition to ventilatory support and hemodynamic management, heparin was administered as anticoagulant therapy postoperatively in the intensive care unit. Multiple thrombi in the pulmonary artery were confirmed on chest CT. On the 4th postoperative day, she was transferred to the general ward without any complications.

Successful Application of Extracorporeal Membrane Oxygenation for 3 Patients in Medical Intensive Care Unit: Case Report: Hye Yun Park, Eun Hae Kang, Hyo Kyoung Choi, Gee Young Suh, O Jung Kwon, Kiick Sung, Young Tak Lee; Korean J Crit Care Med. 2007;22(2):91-95.

Abstract PDF: Extracorporeal membrane oxygenation (ECMO) is a life-sustaining salvage therapy applied to the patient with acute heart failure or respiratory failure which is considered curable, but uncorrectable by conventional means. Recently, accumulating data has shown the survival benefit of ECMO in patients with acute fatal cardiopulmonary decompensation. Here, we report a series of cases of successful ECMO treatment in patients with acute cardiopulmonary insufficiency. Case 1: A patient with progressive respiratory failure on mechanical ventilation after pneumonectomy was managed satisfactorily using a veno-venous ECMO. Case 2: A veno-arterial ECMO was used to support a patient with vasopressor refractory septic shock. After 5 days of treatment, the patient was successfully weaned from ECMO. Case 3: A patient in cardiac arrest after the orthopedic surgery was resuscitated using a veno-arterial ECMO. Pulmonary angiography on ECMO revealed massive pulmonary thromboembolism and embolectomy was thoroughly performed under the support of ECMO.

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