Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-29T05:28:17.049Z Has data issue: false hasContentIssue false
  • English
  • Français

Neurologically normal survival after fibrinolysis during prolonged cardiac arrest: case report and discussion

Published online by Cambridge University Press:  21 May 2015

Kevin Clark ,
Riyad B. Abu-Laban ,
Peter J. Zed  and
Lois Graham
Kevin Clark
Affiliation:
University of British Columbia FRCP Emergency Medicine Residency Program, Vancouver, BC
Riyad B. Abu-Laban*
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, and Division of Emergency Medicine, University of British Columbia
Peter J. Zed
Affiliation:
CSU Pharmaceutical Sciences, Vancouver General Hospital, and Faculty of Pharmaceutical Sciences, Vancouver General Hospital, University of British Columbia, Vancouver, BC
Lois Graham
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, and Division of Emergency Medicine, University of British Columbia
*
Department of Emergency Medicine, Vancouver General Hospital, 855 W. 12th. Ave., Vancouver BC V5Z 1M9; 604 875-4700, fax 604 875-4872, abulaban@interchange.ubc.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Cardiac arrest secondary to pulmonary embolism is a devastating condition with a high mortality rate. It is currently unclear whether fibrinolysis (thrombolysis) is beneficial in this setting. We report the case of a 28-year-old woman with a pulmonary embolism who developed return of pulses following the administration of tissue plasminogen activator after 38 minutes of pulseless electrical activity cardiac arrest. She went on to make a full neurologic and cardiopulmonary recovery. This case is discussed with reference to the current literature on the subject.

Keywords

cardiac arrestfibrinolysisthrombolysispulmonary embolism
Type
Case Report • Observations De Cas
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 1 , January 2003 , pp. 49 - 53
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Wood, KE.Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121:877–905.Google Scholar
2.7C: A guide to the international ACLS algorithms. Circulation 2000;102(suppl I):142–57.Google Scholar
3.Schoenfeld, CN.Pulmonary embolism. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide. New York: McGraw Hill; 2000. p. 396–401.Google Scholar
4.Hyers, TM, Agnelli, G, Hull, R, Morris, TA, Samama, M, Tapson, V, et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001;119(suppl):176S–93S.Google Scholar
5.MacCarthy, P, Worrall, A, McCarthy, G, Davies, J.The use of transthoracic echocardiography to guide thrombolytic therapy during cardiac arrest due to massive pulmonary embolism. Emerg Med J 2002;19:178–9.CrossRefGoogle ScholarPubMed
6.Goldhaber, SZ, Haire, WD, Feldstein, ML, Miller, M, Toltzis, R, Smith, JL, et al. Alteplase versus heparin in acute pulmonary embolism: randomized trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507–11.Google Scholar
7.Konstantinides, S, Geibel, A, Heusel, G, Heinrich, R, Kasper, W.Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347 (15):1143–50.CrossRefGoogle ScholarPubMed
8.Goldhaber, SZ.Thrombolysis for pulmonary embolism. N Engl J Med 2002;347(15):1131–2.Google Scholar
9.Kurkciyan, I, Meron, G, Sterz, F, Janata, K, Domanovits, H, Holzer, M, et al. Pulmonary embolism as cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160:1529–35.CrossRefGoogle ScholarPubMed
10.Courtney, DM, Sasser, HC, Pincus, CL, Kline, JA.Pulseless electrical activity with witnessed arrest as a predictor of sudden death from massive pulmonary embolism in outpatients. Resuscitation 2001;49:265–72.Google Scholar
11.Stueven, HA, Aufderheide, T, Waite, EM, Mateer, JR.Electromechanical dissociation: Six years prehospital experience. Resuscitation 1989;17:173–82.Google Scholar
12.Bonnin, MJ, Pepe, PE, Kimball, KT, Clark, PS.Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 1993;270:1457–62.Google Scholar
13.van der Wouw, PA, Koster, RW, Delemarre, BJ, de Vos, R, Lampe-Schoenmaeckers, AJ, Lie, KI.Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation. J Am Coll Cardiol 1997;30:780–3.CrossRefGoogle ScholarPubMed
14.Varriale, P, Maldonado, JM.Echocardiographic observations during inhospital cardiopulmonary resuscitation. Crit Care Med 1997;1997:10.Google Scholar
15.Calinas-Correia, J, Phair, I.Is there a pulse? Resuscitation 1999; 41:201–2.Google Scholar
16.Cripps, T, Camm, J.The management of electromechanical dissociation. Resuscitation 1991;22:173–80.Google Scholar
17.Langdon, RW, Swicegood, WR, Schwartz, DA.Thrombolytic therapy of massive pulmonary embolism during prolonged cardiac arrest using recombinant tissue-type plasminogen activator. Ann Emerg Med 1989;18(6):678–80.Google Scholar
18.Kohle, W.[Thrombolysis in resuscitated patients with pulmonary embolism.] Anaesthesist 1984;33:469.Google Scholar
19.Scholz, KH, Hilmer, T, Schuster, S, Wojcik, J, Kreuzer, H, Tebbe, U.Thrombolyse bei reanimierten patienten mit lungenembolie (German). Dtsch Med Wschr 1990;115:930–5.Google Scholar
20.Westhoff-Bleck, M.Lysetherapie bie protraheirter kardio-pulmonaler reanimation: nutzen und komplikationen. Z Kardiol 1991;80:139 [137 to 143]Google Scholar
21.Bottiger, BW, Reim, SM, Diezel, G, Bohrer, H, Martin, E.High-dose bolus injection of urokinase: use during cardiopulmonary resuscitation for massive pulmonary embolism. Chest 1994;106:1281–3.Google Scholar
22.Pharo, GH, Andonakakis, A, Chandrasekaren, K, Amron, G, Levitt, JD.Survival from catastrophic intraoperative pulmonary embolism. Anesth Analg 1995;81:188–90.Google Scholar
23.Schulte-Sinkus, D, Standl, T.[Successful resuscitation after bolus injection of tissue-type plasminogen activator in emergency admission.] Anasthesiol Intensivmed Notfallmed Schmerzther 1998;33:124–8.Google Scholar
24.Newman, DH, Greenwald, I, Callaway, CW.Cardiac arrest and the role of thrombolytic agents. Ann Emerg Med 2000;35:472–0.Google Scholar
25.Bottiger, BW, Bode, C, Kern, S, Gries, A, Gust, R, Glatzer, R, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet 2001;357:1583–5.CrossRefGoogle ScholarPubMed
26.Lederer, W, Lichtenberger, C, Pechlaner, C, Kroesen, G, Baubin, M.Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest. Resuscitation 2001;50:71–6.Google Scholar
27.Abu-Laban, RB, Christenson, JM, Innes, GD, van Beek, CA, Wanger, KP, McKnight, RD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 2002;346:1522–8.Google Scholar
28.Tiffany, PA, Schultz, M, Steuven, H.Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series. Ann Emerg Med 1998;31:124–6.CrossRefGoogle ScholarPubMed
29.Bottiger, B, Padosch, SA, Wenzel, V.Tissue plasminogen activator in cardiac arrest with pulseless electrical activity [letter]. N Engl J Med 2002;347:1281.Google ScholarPubMed
30.Abu-Laban, RB, Christenson, JM, Innes, GD.Tissue plasminogen activator in cardiac arrest with pulseless electrical activity [letter]. N Engl J Med 2002;347:1282.Google Scholar