Original Articles
Recognition and management of catheter-induced pulmonary artery rupture

https://doi.org/10.1016/S0003-4975(98)00593-1Get rights and content

Abstract

Background. Catheter-induced pulmonary artery rupture is a well-recognized complication of invasive monitoring, but the risk has not diminished. Although commonly associated with cardiopulmonary bypass, injuries also occur in intensive care. Definitive proof requires pulmonary angiography or autopsy. Many cases are never reported, and lesser injuries are probably underdiagnosed.

Methods. Seven cases fulfilling accepted diagnostic criteria discovered over 2 years are described in four groups illustrating the common modes of presentation: hemoptysis with hypoxemia, exsanguination, delayed recurrent hemorrhage, and bleeding with cardiopulmonary bypass.

Results. One patient had a planned elective operation deferred. Four patients were being monitored in intensive care. Two of them died of pulmonary artery rupture. Two other patients had bleeding on weaning from cardiopulmonary bypass. One settled with conservative treatment, the other survived after extracorporeal life support. Recognition and management are discussed, emphasizing means of avoiding pulmonary resection.

Conclusions. Catheter-induced pulmonary artery rupture is unavoidable. Constant awareness is essential. A plan of management is presented. Extracorporeal life support may help to avoid pulmonary resection. Early pulmonary angiography is advocated for accurate diagnosis and to enable treatment by embolization.

Section snippets

Material and methods

We report 7 cases of PA rupture encountered over 2 years (June 1995 to June 1997), to illustrate options in management. Three of these cases were among 1,500 operations using cardiopulmonary bypass (CPB). One of these patents survived after extracorporeal life support (ECLS). All incidents occurred in a tertiary referral teaching hospital where approximately 750 open heart operations are performed each year, and which has a separate 14-bed general intensive care unit. A heparin-coated

Comment

Pulmonary artery rupture from catheter injury during invasive monitoring is an uncommon but often lethal complication. Comprehensive reviews of the literature have been done 4, 5, 6, 14. The reported incidence is between 0.2% and 1.0% 2, 6, 14 with a mortality of 50% 4, 6, 8. Hence it is essential to maintain a high level of suspicion and to have a clear plan of management. Such plans have been formulated previously, covering endobronchial bleeding occurring during preoperative insertion 2, 5, 6

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