b) Operative Therapie und Verfahrenswahl bei der Lungenembolie
In den letzten Jahren wurden große Fortschritte mit der Embolektomie unter Anwendung der Herz-Lungen-Maschine erzielt. Diese Methode ist aber nur anwendbar bei Patienten, welche die Embolie 1–2 Std überleben, weil exakte Diagnostik und das Anschließen der Herz-Lungen-Maschine immer noch gewisse Zeit erfordern.
In the past few years great advances in embolectomy have been achieved through the use of the heart-lung maschine. This method, however, can be applied only in patients who survive the embolism for one or two hours because accurate diagnosis and the connection of the heart-lung machine still require some time. For patients who become unconscious after a few minutes and show circulatory arrest this time is no longer available. They can, however, still be saved by immediate transsternal embolectomy with temporary clamping of the vena cava without further diagnostic measures and useless conservative attempts at reanimation if the clinic is suitably organised. This method can also be employed in hospitals and clinics which do not possess a heart-lung machine. At Giessen 15 out of 64 patients have so far survived for over 8 days, and 9 were discharged cured. The commonly held view that these patients would have survived even without successful emergency embolectomy is erroneous. The deleterious clinical course before the operation and the large thrombo-emboli removed by embolectomy prove the lifesaving importance of our operations.
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