Journal of Clinical Anesthesiology: Open Access

Purpose: The purpose of this case report is to demonstrate the management of a parturient with a life-threatening pulmonary embolism in the antenatal and perinatal phase of her care. In addition to this, it is important to highlight cardiopulmonary resuscitation which was titrated by life radiological imaging during rescue catheter embolectomy. By observing these images, the medical team appreciated the progressive hypokinesis of the myocardium and thus anticipating prompt and high-quality chest compressions.

Clinical Features: A 24-year-old woman at 37 weeks and 4 days gestation who was transferred from an outside hospital on a heparin infusion to our University Medical Center for peripartum care and management of a suspected pulmonary embolism (PE). On admission she was extremely tachycardic and short of breath. She underwent an emergent cesarean delivery at the mother’s request for category 3 non-reassuring fetal heart tones. After induction of general anesthesia, she became profoundly hypotensive despite ongoing fluid resuscitation and vasopressor support. A transesophageal echo (TEE) revealed a dilated right ventricle with severe right heart strain. Inhaled nitric oxide and a milrinone infusion were started due to cardiogenic shock. The decision was made to transfer her to the interventional radiology (IR) suite for an emergent pulmonary angiography and a rescue catheter embolectomy. While performing the embolectomy in the interventional radiology suite, the patient suffered three episodes of cardiac arrest. During continuous x-ray screening we were able to appreciate real-time images of the heart during the full cardiac cycle, the right ventricle appeared visibly dilated and hypokinetic. Contractility continued to progressively get worse up until the point of cardiac arrest after each event. We were able to guide further therapeutic decisions (ongoing fluid therapy, vasopressor, and inotropic support) based on the real-time fluoroscopy images that were visualized. Continuous images during this period of hemodynamic instability were captured along with the images of the thrombectomy catheter removing large amounts of embolic thrombus from both pulmonary arteries.

Conclusion: Patients who are undergoing interventional radiological procedures are often too sick to undergo major surgery and in this scenario the utility of live x-ray was paramount to the quality of chest compressions and thus survival of this patient 1.

I am pleased to mention that during the year 2019, all issues of volume 8 were published online well within the time and the print issues were also brought out and dispatched within 30 days of publishing the issue online. JCAO also brought out an online special issue in 2019. JCAO Published 3 research Article 1 case report 2019. In 2018 JCAO Published 2 Research Article and 3 case report. The H-index of the journal, however, will get soon . During the calendar year 2019, JCAO received a total of 8 papers, out of which 4 articles (50%) were rejected in the preliminary screening due to plagiarism or being out of the format. During 2019 around 20 articles were subjected to the peer-review process and 4 of those were accepted. In the 3 Volume 4 published during the year 2019, a total of 4 articles were published of which, 50 % articles were by foreign authors. A total of 5 research scientists from India and abroad reviewed the 2 articles published in volume 3. Average publication lag time of an article was further reduced to 6-8 weeks. I take this opportunity to acknowledge the contribution of John F. Bebawy, the final editing of articles published and the support rendered by the editorial assistant, Olivia Bratt bringing out issues of JCAO in time. I would also like to express my gratitude to all the authors, reviewers, the publisher, the advisory and the editorial board of JCAO, the office bearers and staff of IPA secretariat for their support in bringing out yet another volume of JCAO and look forward to their unrelenting support to bring out the Volume 3 of JCAO in scheduled time.