The Thai Incident Monitoring Study (Thai AIMS) of Suspected Pulmonary Embolism: An Analysis of 1,996 Incident Reports
Tee Chularojmontri MD*, Intiporn Kositanurit MD**, Somrat Charuluxananan MD***, Wimonrat Sriraj MD****, Yodying Punjasawadwong MD*****, Aksorn Pulnitiporn MD******
Affiliation : * King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ** Faculty of Medicine, Naresuan University, Phitsanulok, Thailand *** Faculty of Medicine, Chulalongkorn University and Chulalongkorn Research Center for Quality, Safety and Innovation in Patient Care, Bangkok, Thailand **** Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ***** Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ****** Khon Kaen Regional Hospital, Khon Kaen, Thailand
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.
Keywords : Pulmonary embolism, Hypoxia, Hypotension, Cardiac arrest, Complications
