Embolectomy phẫu thuật ngay lập tức, có hoặc không có bỏ qua tim phổi, cung cấp một tùy chọn để nhanh chóng khôi phục lại việc lưu thông và oxy hóa ở những bệnh nhân với PE lớn và sự sụp đổ tuần hoàn. | Cardiovascular Emergencies Thrombolysis with TPA should be first line treatment for patients with PE in the presence of hypotension severe hypoxia or other evidence of marked haemodynamic compromise Surgical embolectomy Immediate surgical embolectomy with or without cardiopulmonary bypass provides an option to rapidly restore the circulation and oxygenation in patients with massive PE and circulatory collapse. Comparisons of surgical embolectomy have been performed but these are very small studies often non-randomised and have shown that the mortality of patients undergoing surgical embolectomy is substantial 30 as expected in this high-risk The requirement for preoperative cardiopulmonary resuscitation CPR is an indicator of poor outcome 70 mortality and whilst immediate embolectomy in the setting of circulatory arrest may occasionally be life saving rapid institution of cardiopulmonary bypass allows embolectomy under more controlled Embolectomy may offer an alternative to patients with PE and severe circulatory compromise in whom thrombolytics are contraindicated or have been However the principal limitation of surgical embolectomy as a treatment strategy for massive PE lies in the fact that specialised cardiothoracic units are not immediately available to the majority of patients sick enough to justify this approach. Treatment of pulmonary embolism long-term issues Long-term anticoagulation Initial treatment with heparin should be followed by commencement of oral anticoagulation with warfarin as soon as the diagnosis of PE is confirmed aiming for a INR of . For PE in the setting of a remediable underlying cause . surgery immobility anticoagulation for 6 weeks is 190 Pulmonary embolism adequate. Other patients in whom predisposing factors might be considered to continue . heart failure the incidence of recurrent PE is significant and anticoagulation should be continued for longer usually 3 or 6 .
