Pulmonary Embolism Caused by Tourniquets in the Lower Extremities Treated with ECMO – A Case Report
Keywords:acute pulmonary embolism, ECMO
Background: Using tourniquets in the lower extremities can increase the incidence of deep vein thrombosis (DVT). Acute large-area pulmonary embolism (APE) occurs in severe cases, and it is fatal to most patients. Acute large-area pulmonary embolism causes haemodynamic instability, right heart failure, and circulatory failure.
Case presentation: A 47-year-old female patient was subjected to spinal anaesthesia for a comminuted fracture of the tibia and fibula of the left lower limb. After the tourniquet was released during the operation, she had sudden hypotension and lost consciousness. Thus, ECMO was used to support patient circulation. With ECMO-assisted CT examination, she was diagnosed to have a pulmonary embolism. On the next day, she was subjected to a bilateral pulmonary embolism and embolectomy. Lastly, she was transferred to the general ward and discharged smoothly.
Conclusions: Patients undergoing fracture surgery should be wary of APE caused by the loss of DVT after the release of tourniquets. ECMO, as a rapid and effective temporary life support intervention, provides effective cardiopulmonary support and new treatment plans. It also saves time for further treatment of patients with high-risk APE.
Bogdan Y, Helfet DL. 2018. Use of Tourniquets in Limb Trauma Surgery[J]. Orthop Clin North Am. 49(2):157-165.
Cai DF, Fan QH, Zhong HH, et al. 2019. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis[J]. J Orthop Surg Res. 14(1):348.
Grant CJ, Richards JB, Frakes M, et al. 2021. ECMO and Right Ventricular Failure: Review of the Literature[J]. J Intensive Care Med. 36(3):352-360.
Martinez LC, McCurdy CM, Maldonado SM, et al. 2020. Current Management of Acute Pulmonary Embolism[J]. Ann Thorac Cardiovasc Surg. 26(2):65-71.
Parmet JL, Horrow JC, Berman AT, et al. 1998. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use[J]. Anesth Analg. 87(2):439-444.
QiMin W, LiangWan C, DaoZhong C, et al. 2020. Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China[J]. J Cardiothorac Surg. 15(1):321.
Siao FY, Chiu CC, Chiu CW, et al. 2015. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation[J]. Resuscitation. 92:70-76.
Yi S, Tan J, Chen C, et al. 2014. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis[J]. Arch Orthop Trauma Surg. 134(10):1469-1476.
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