Successful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report
Keywords:
Pulmonary embolism, Fibrinolytic agents, Fibrinolysis, Heart arrest, Thrombolytic therapy
Abstract
Massive pulmonary thromboembolism is a condition with high morbidity and mortality if not treated early. A case of a young man with a history of knee trauma that was admitted to the emergency department with sudden dyspnea and syncope is discussed. During the clinical evaluation the patient experienced 5 episodes of cardiac arrest that required prolonged cardiopulmonary-cerebral resuscitation. The diagnosis of massive pulmonary thromboembolism was confirmed by echocardiography and thoracic CT angiography. Although prolonged cardiopulmonary-cerebral resuscitation is a relative contraindication for systemic thrombolysis, the patient experienced remarkable clinical improvement with no sequelae upon hospital discharge.
References
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14. Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galié N, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35:3033-73.
15. Shah KJ, Scileppi RM, Franz RW. Treatment of pulmonary embolism using ultrasound-accelerated thrombolysis directly into pulmonary arteries. Vasc Endovasc Surg. 2011;45:541-8.
16. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med. 2012;125:465-70.
17. Quintana D, Salsamendi J, Fourzali R, Narayanan G. Ultrasound-assisted thrombolysis in submassive and massive pulmonary embolism: assessment of lung obstruction before and after catheter-directed therapy. Cardiovasc Intervent Radiol. 2014;37:420-6.
18. Stein PD, Matta F, Steinberger DS, Keyes DC. Intracerebral hemorrhage with thrombolytic therapy for acute pulmonary embolism. Am J Med. 2012;125:50-6.
19. Condliffe R, Elliot CA, Hughes RJ, Hurdman J, Maclean RM, Sabroe I, et al. Management dilemmas in acute pulmonary embolism. Thorax. 2014;69:174-80.
20. Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest: case report and systematic review of controlled trials. Ann Pharmacother. 2010;44:2007-13.
21. Bottiger BW, Arntz HR, Chamberlain DA, Bluhmki E, Belmans A, Danays T, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 2008;359:2651-62.
2. Takach Lapner S, Kearon C. Diagnosis and management of pulmonary embolism. BMJ. 2013;346:f757.
3. Tapson VF. Thrombolytic therapy in acute pulmonary embolism. Curr Opin Cardiol. 2012;27:585-91.
4. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585-93.
5. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933-8.
6. Douma RA, Kamphuisen PW, Buller H. Acute pulmonary embolism. Part 1: epidemiology and diagnosis. Nat Rev Cancer. 2010;7:585-96.
7. Robert-Ebadi H, Righini M. Diagnosis and management of pulmonary embolism in the elderly. Eur J Intern Med. 2014;25:343-9.
8. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107 23 (Suppl. 1):I4-8.
9. Goldhaber SZ. Pulmonary embolism. Lancet. 2004;363:1295-305.
10. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28:370-2.
11. Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med. 2004;117:19-25.
12. Dennis J, Rojas M, Molina A, Roa J, Granados M, Londoño A, et al. Curso clínico y supervivencia en embolia pulmonar: resultados del registro multicéntrico colombiano (EMEPCO). Acta Med Colomb. 2008;33:111-6.
13. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemora deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788-830.
14. Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galié N, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35:3033-73.
15. Shah KJ, Scileppi RM, Franz RW. Treatment of pulmonary embolism using ultrasound-accelerated thrombolysis directly into pulmonary arteries. Vasc Endovasc Surg. 2011;45:541-8.
16. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med. 2012;125:465-70.
17. Quintana D, Salsamendi J, Fourzali R, Narayanan G. Ultrasound-assisted thrombolysis in submassive and massive pulmonary embolism: assessment of lung obstruction before and after catheter-directed therapy. Cardiovasc Intervent Radiol. 2014;37:420-6.
18. Stein PD, Matta F, Steinberger DS, Keyes DC. Intracerebral hemorrhage with thrombolytic therapy for acute pulmonary embolism. Am J Med. 2012;125:50-6.
19. Condliffe R, Elliot CA, Hughes RJ, Hurdman J, Maclean RM, Sabroe I, et al. Management dilemmas in acute pulmonary embolism. Thorax. 2014;69:174-80.
20. Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest: case report and systematic review of controlled trials. Ann Pharmacother. 2010;44:2007-13.
21. Bottiger BW, Arntz HR, Chamberlain DA, Bluhmki E, Belmans A, Danays T, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 2008;359:2651-62.
How to Cite
1.
Chicangana G, Zapata L, Gómez JC, Zuluaga JP. Successful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report. Colomb. J. Anesthesiol. [Internet]. 2016 Jul. 1 [cited 2024 Apr. 24];44(3):245-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/379
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Published
2016-07-01
How to Cite
1.
Chicangana G, Zapata L, Gómez JC, Zuluaga JP. Successful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report. Colomb. J. Anesthesiol. [Internet]. 2016 Jul. 1 [cited 2024 Apr. 24];44(3):245-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/379
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Section
Case Report / Case Series
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