Improved diagnosis of pulmonary embolism causing cardiac arrest by combined endobronchial ultrasound and echocardiography.
Pietro Bertini, Alessandro Ribechini, Fabio Guarracino
Author Information
Pietro Bertini: Department of Anaesthesia and Critical Care, Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy. pietro.bertini@gmail.com. ORCID
Fabio Guarracino: Department of Anaesthesia and Critical Care, Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
BACKGROUND: Pulmonary embolism (PE) is a life-threatening disease difficult to diagnose and manage in severe hemodynamic unstable patients. Transoesophageal echocardiography (TEE) is considered useful to improve diagnosis, but such approach has physical limitations for the interposition of the airways preventing the clear assessment of the left pulmonary artery. Endobronchial ultrasound (EBUS), a recently developed technique carried out using a modified bronchoscope having a small ultrasound convex probe at the tip allowing to perform ultrasonography examination of the mediastinum, can extensively visualize the pulmonary arteries on both sides. CASE PRESENTATION: We present the first use of EBUS to rapidly diagnose and subsequently treat a 64 years old woman with history of lateral amyotrophic sclerosis admitted to the intensive care unit (ICU) for severe dyspnoea and rapidly experiencing a cardiac arrest. CONCLUSIONS: Combined bedside EBUS and echocardiography allowed to rapidly diagnose the cause of cardiac arrest and avoid risks related to transferring the critical patient to the radiology department.
