THE NOVEL USE OF NEBULIZED TRANEXAMIC ACID FOR MASSIVE HEMOPTYSIS IN THE SETTING OF ACUTE STENT PLACEMENT AND DUAL ANTIPLATELET THERAPY POST CARDIAC ARREST

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Traumatic lung injury is a common complication following CPR. We present a case with massive hemoptysis following CPR, using the LUCAS chest compression system, in whom nebulized tranexamic acid was used to control the bleeding after acute coronary stent placement and being placed on DAPT CASE PRESENTATION: A 57-year-old male with no known PMHx presented to the ER after a witnessed cardiac arrest. CPR was started by the wife. On EMS arrival, the patient was in VF arrest and CPR continued on a LUCAS chest compression system for about 40 minutes before ROSC was achieved in the ER where the patient was intubated. The patient was found to have an acute STEMI and was taken emergently to the cath lab and underwent percutaneous coronary intervention with a drug-eluting stent to the proximal ramus and was started on DAPT (Aspirin and Ticagrelor) The patient was started on a hypothermia protocol and cooled to 32°C for 24 hours before rewarming was initiated After rewarming, on day 4 of hospitalization, the patient was noted to have worsening respiratory distress with increasing PEEP and FiO2 requirements. The patient also had progressively worsening bloody secretions from the ET tube over the previous 24 hours (approximately 300mL). A bronchoscopy was done and showed intra-alveolar hemorrhage with additional 100-150mL suctioned during bronchoscopy. The patient received one dose of nebulized tranexamic acid 500 mg in an attempt to stop the bleeding. The patient was then placed in the prone position, paralyzed with Cisatracurium, and ventilated per our ARDS protocol using 6 ml/kg PBW tidal volume goal. After 24 hours, he had significant improvement in his breathing status with cessation of the bloody secretions from the ETT. The patient was extubated 4 days later. The patient showed gradual improvement in his mental and functional status and was eventually transferred to a long-term care facility in stable condition DISCUSSION: Massive hemoptysis secondary to lung trauma is a complication of CPR. In this case, the patient developed massive hemoptysis following cardiac arrest with prolonged CPR using a LUCAS chest compression system and aggravated by starting him on DAPT after stent placement. Following one dose of inhaled tranexamic acid 500 mg followed by ventilating the patient with our ARDS protocol, there was a rapid improvement in his respiratory status with cessation of the bleeding. Tranexamic acid is a fibrinolysis inhibitor that works by displacing plasminogen from fibrin. Inhaled tranexamic acid has been used to treat hemoptysis. Its use in this case of massive hemoptysis following CPR while the patient is on DAPT after a new stent placement demonstrates a potential for its use in similar cases if more studies are conducted CONCLUSIONS: Inhaled tranexamic acid was effective in controlling massive hemoptysis following prolonged CPR in a patient on DAPT after a new stent placement Reference #1: Inhaled tranexamic acid as an alternative for hemoptysis treatment Calvo G.S., De Granda-Orive I., Padilla D.L. (2016) Chest, 149 (2), pp. 604 DISCLOSURES: No relevant relationships by Abdullah Al-abcha, source=Web Response No relevant relationships by Sherif Elkinany, source=Web Response No relevant relationships by Asfar Ghauri, source=Web Response No relevant relationships by Angela Smolarz, source=Web Response