The benefits of early thrombolysis during cardiac arrest of a patient with ultrasonic confirmation of pulmonary embolus

Abstract

Introduction: Pulmonary embolism is an extremely common but life threatening condition. Mortality rate from cardiac arrests due to pulmonary embolus remains high. Thrombolysis is an option for definitive treatment. However, the diagnosis of PE during cardiac arrest is difficult and often thrombolysis is not considered. Materials and method: A case report is presented. Case report: A 28-year-old female presented at the accident and emergency department with a 3-day history of left calf pain and swelling. A deep vein thrombosis was suspected. Ultrasound confirmed an established thrombus in the mid femoral vein. On leaving the department the patient collapsed with severe respiratory distress, which rapidly proceeded to a respiratory arrest. Resuscitation was commenced with bag valve mask ventilation with oxygen, IV fluids. After approximately 10 min, the patient developed Pulseless Electrical Activity (PEA). Cardiopulmonary resuscitation was commenced. At this time, 5000 units of heparin was given. After two cycles of CPR (each lasting 3 min), 8000 units of Tenecteplase was given intravenously …. ROSC was noted at 15 min from the time of cardiac arrest. CT pulmonary angiogram confirmed pulmonary emboli present in the distal parts of the left and right pulmonary artery. Treatment was managed medically with thrombolysis and anticoagulation. The patient made a remarkable recovery and was discharged from hospital neurologically intact 7 days after her admission and remains alive to date. Conclusion: Thrombolysis needs to be considered early as a treatment option for patients in cardiac arrest where the cause is thought to be pulmonary embolism. It is now being more recognised that CPR should not be considered a contraindication to thrombolysis.