The Thai incident monitoring study (Thai AIMS) of suspected pulmonary embolism: An analysis of 1,996 incident reports

Abstract

Background: The present study is part of the multicenter study of model of anesthesia related adverse events in Thailand by Incident Report (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objectives of the present study were to determine the frequency, clinical presenting, and outcomes of suspected pulmonary embolism. Material and Method: The present study is a prospective descriptive research design. Three anesthesiologists extracted relevant data from the incident reports on suspected pulmonary embolism from the Thai AIMS database collected during the study period between January 1 and June 30, 2007. Descriptive statistics was used. Results: After exclusion of four irrelevant or unlikely pulmonary embolism patients, there were 12 cases of suspected pulmonary embolism (0.6% of 1996 incident reports). Four cases (25%) were operated under emergency conditions. One incident (8.3%), eight incidents (67.7%), and three incidents (25%) were diagnosed by clinical diagnosis in preoperative, intra-operative, and 24-hour postoperative period. Common clinical manifestations were hypoxia (91.7%), hypotension (91.7%), and cardiac arrest (50%) at time of diagnosis. The mortality rate of obstetric surgery, orthopedic surgery, and general surgery were 42.8% (3 out of 7), 50% (2 out of 4), and 0% (0 out of 1 patient) with a total mortality rate of 41.7%. Only two patients (16.6%) that had incidental cardiac arrest survived. There were two cases (16.6%) of preventable incidents due to incorrect usage of pressure pump for rapid IV infusion. Conclusion: Diagnosis of pulmonary embolism was difficult. The incidents were rare. Hypoxia and hypotension were the most common manifestations. Perioperative mortality rate was high (41.7%) despite prompt cardiopulmonary support. Most incidents were unexpected. An air embolism due to incorrect use of pressure pump for rapid IV infusion was considered preventable. Further epidemiologic studies for thromboembolism prophylaxis in Thailand are needed.