The following measures have revolutionized the management of patients with massive pulmonary embolism: (1) Closed chest massage will preserve brain viability while preoperative circulatory support is begun through groin cannulations under local anaesthesia. (2) Obligatory pulmonary angiography is carried out in operating room during circulatory support. (3) Subsequent anesthesia and thoracotomy is made safe with pump support. (4) Experimental studies in ten dogs and experience in three patients has demonstrated the value of closed chest massage in propelling a proximal pulmonary artery embolus into the distal arterial tree. This allows resumption of some pulmonary blood flow, a distinct improvement in hemodynamics, and patient recovery without surgery.
Eighteen patients were managed in this way, seven without embolectomy (six survivors); 11 underwent embolectomy (ten survivors). In the absence of caval surgery there has been no further embolism in a follow-up of one to seven years.
Heimbecker RO, Keon WJ, Richards KU. Massive Pulmonary EmbolismA New Look at Surgical Management. Arch Surg. 1973;107(5):740-746. doi:10.1001/archsurg.1973.01350230092018