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Welle SR, Harrison MF. Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931215. [PMID: 34228699 PMCID: PMC8272940 DOI: 10.12659/ajcr.931215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/31/2021] [Accepted: 05/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately 290 000 cases of in-hospital cardiac arrest occur annually, the majority of which are due to cardiac or respiratory causes. Cardiac arrest due to acute pulmonary embolism (PE) is associated with a 90% incidence of mortality and, if identified, it can be treated with systemic thrombolytics. Here, we describe a case in which the outcome for such an event was favorable. CASE REPORT A 66-year-old woman was admitted with multiple rib and left ankle fractures due to accidental trauma. Before undergoing orthopedic surgery, she experienced a cardiac arrest with pulseless electrical activity, which was witnessed. She had refractory hypoxia and hypotension following intubation and a brief initial return of spontaneous circulation (ROSC) before a second cardiac arrest. A 100-mg bolus dose of systemic thrombolytic therapy was promptly administered, with rapid achievement of sustained ROSC. The results of a subsequent electrocardiogram, echocardiogram, and computed tomography scan further supported the diagnosis of acute PE with right heart strain. Supportive care in the Intensive Care Unit resulted in full neurological recovery and she was discharged to a physical rehabilitation facility 12 days after her cardiac arrest. CONCLUSIONS Systemic thrombolytic therapy is beneficial for cardiac arrest due to acute PE.
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Affiliation(s)
- Stephanie R. Welle
- Department of Intensive Care (Critical Care), Mayo Clinic Health System, Mankato, MN, USA
| | - Michael F. Harrison
- Department of Intensive Care (Critical Care), Mayo Clinic Health System, Mankato, MN, USA
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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Abstract
High-quality cardiopulmonary resuscitation, in particular chest compressions, is a key aspect of out-of-hospital cardiac arrest (OHCA) resuscitation. Manual chest compressions remain the standard of care; however, the extrication and transport of patients with OHCA undermine the quality of manual chest compressions and risk the safety of paramedics. Therefore, in circumstances whereby high-quality manual chest compressions are difficult or unsafe, paramedics should consider using a mechanical device. By combining high-quality manual chest compressions and judicious application of mechanical chest compressions, emergency medical service agencies can optimize paramedic safety and patient outcomes.
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Affiliation(s)
- Kylie Dyson
- Centre for Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia; Cardiology Department, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia; Cardiology Department, Western Health, Gordon Street, Footscray, VIC 3011, Australia; Medical Directorate, Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia; Medical Directorate, Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC 3199, Australia
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Review and Outcome of Prolonged Cardiopulmonary Resuscitation. Crit Care Res Pract 2016; 2016:7384649. [PMID: 26885387 PMCID: PMC4738728 DOI: 10.1155/2016/7384649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/29/2015] [Accepted: 12/22/2015] [Indexed: 01/24/2023] Open
Abstract
The maximal duration of cardiopulmonary resuscitation (CPR) is unknown. We report a case of prolonged CPR. We have then reviewed all published cases with CPR duration equal to or more than 20 minutes. The objective was to determine the survival rate, the neurological outcome, and the characteristics of the survivors. Measurements and Main Results. The CPR data for 82 patients was reviewed. The median duration of CPR was 75 minutes. Patients mean age was 43 ± 21 years with no significant comorbidities. The main causes of the cardiac arrests were myocardial infarction (29%), hypothermia (21%), and pulmonary emboli (12%). 74% of the arrests were witnessed, with a mean latency to CPR of 2 ± 6 minutes and good quality chest compression provided in 96% of the cases. Adjunct therapy included extracorporeal membrane oxygenation (18%), thrombolysis (15.8%), and rewarming for hypothermia (19.5%). 83% were alive at 1 year, with full neurological recovery reported in 63 patients. Conclusion. Patients undergoing prolonged CPR can survive with good outcome. Young age, myocardial infarction, and potentially reversible causes of cardiac arrest such as hypothermia and pulmonary emboli predict a favorable result, especially when the arrest is witnessed and followed by prompt and good resuscitative efforts.
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