Direct intraclot thrombolysis for cardiac arrest following massive pulmonary embolism in a neurosurgical patient. Treating on the edge?

Successful thrombolytic therapy of post-operative massive pulmonary embolism after ultralong cardiopulmonary resuscitation: a case report and review of literature

BACKGROUND AND AIMS

Cardiac arrest caused by massive pulmonary embolism (PE) is highly refractory to conventional resuscitation. Thrombolytic therapy has been considered to be an effective way to massive PE.

METHODS

We reported a case of successful thrombolytic therapy of post-operative massive PE after 90-min cardiopulmonary resuscitation (CPR) and reviewed the relevant literature.

RESULTS

We presented the case of a 48-year-old woman with surgery of varicosis of great saphenous vein who suffered from a massive PE with circulatory arrest refractory to 90 min of aggressive CPR. Thrombolysis was given only as a single dose of 50 mg of recombinant tissue plasminogen activator. Rapid haemodynamic and clinical improvement followed the bolus dose. The patient was discharged later without neurological or other sequelae. An extensive literature search of the PubMed database only identified 11 cases of massive PE with cardiac arrest during the perioperative period with a survival rate was 88.9%. The time period of CPR before thrombolysis or anti-coagulation was 15-90 min.

CONCLUSIONS

Thrombolytic therapy is useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive PE during the perioperative period, even in the prolong resuscitation.