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Vajifdar F, Badki P. Low-dose tenecteplase during cardiopulmonary resuscitation in massive pulmonary embolism. Int J Emerg Med 2024; 17:82. [PMID: 38961331 PMCID: PMC11223363 DOI: 10.1186/s12245-024-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
We report the case of an 18-year-old male who presented to the Emergency Department with sudden onset dyspnea. The patient was intubated on arrival, but suffered a cardiac arrest soon after. Point-of-care echocardiography during cardiopulmonary resuscitation revealed a grossly dilated right atrium and right ventricle, which alerted the Emergency physician to the possibility of massive pulmonary embolism leading to cardiac arrest. Due to no discernible history or risk factors in favour of pulmonary embolism, a decision was taken for thrombolysis with half dose Tenecteplase. Return of spontaneous circulation was achieved 14 min after thrombolysis, with massive pulmonary embolism subsequently being confirmed on CT Pulmonary Angiography.
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Affiliation(s)
- Farzin Vajifdar
- Department of Emergency Medicine, Holy Family Multispecialty Hospital, Mumbai, India.
| | - Parag Badki
- Intensive Care, Holy Family Multispecialty Hospital, Mumba, India
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2
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Cruz G, Pedroza S, Giraldo M, Peña AD, Calderón CA, Quintero IF. Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review. BMC Anesthesiol 2023; 23:415. [PMID: 38110877 PMCID: PMC10726619 DOI: 10.1186/s12871-023-02370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/03/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE. METHODS A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles. RESULTS A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE. CONCLUSION The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient's characteristics, is necessary for an optimal approach.
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Affiliation(s)
- Gustavo Cruz
- Departamento de anestesiología, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia.
| | - Santiago Pedroza
- Centro de investigaciones clínicas, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Miller Giraldo
- Departamento de cardiología y hemodinamia, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Alvaro D Peña
- Departamento de cirugía cardiovascular, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Camilo A Calderón
- Departamento de cardiología, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Ivan F Quintero
- Departamento de anestesiología, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
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3
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Suzuki Y, Kadoya F, Nishikawa T, Saeki H, Takubo K, Nishida K. Successful Resuscitation Following Intraoperative Acute Pulmonary Embolism With a Focus on Control of Bleeding After Thrombolytic Therapy: A Case Report. A A Pract 2021; 15:e01549. [PMID: 34936578 DOI: 10.1213/xaa.0000000000001549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute pulmonary embolism is a serious perioperative complication. Current guidelines focus on hemodynamic stabilization and rapid restoration of pulmonary artery blood flow. However, various complications, most notably bleeding, are associated with treatment of the embolism. We report a case of acute pulmonary embolism with cardiopulmonary arrest during orthopedic surgery. Prompt thrombolysis and gaining control of both thrombolytic therapy-induced bleeding from the wound and a hepatic cyst enabled the patient to recover without neurological deficits.
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Affiliation(s)
- Yasuyuki Suzuki
- From the Department of Anesthesiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan.,Research Division, Saiseikai Research Institute of Health Care and Welfare, Tokyo, Japan.,Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Fumito Kadoya
- From the Department of Anesthesiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Tomoaki Nishikawa
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Hideyuki Saeki
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Kenji Takubo
- Department of Orthopedics, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Katsuko Nishida
- From the Department of Anesthesiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
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4
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Rodriguez D, Jerjes-Sanchez C, Fonseca S, Garcia-Toto R, Martinez-Alvarado J, Panneflek J, Ortiz-Ledesma C, Nevarez F. Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: a systematic review. J Thromb Thrombolysis 2021; 50:929-941. [PMID: 32347509 DOI: 10.1007/s11239-020-02122-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombolysis in high-risk pulmonary embolism (PE) patients is recommended worldwide; however, the evidence for thrombolysis during pregnancy and the immediate puerperium remains unclear. We conducted a systematic review from 1950 to 2019 through PubMed, Ovid/Willey, and Cochrane Library to assess the safety and effectiveness of thrombolysis during pregnancy and the immediate puerperium. Additionally, we characterized the clinical presentation, risk stratification, and diagnostic approach. We have communicated our results according to the PRISMA statement. We collected 141 records and, after critical assessment, included 47 case reports of 54 patients, including 43 and 11 patients during pregnancy and puerperium, respectively. During pregnancy, alteplase was the most frequent systemic thrombolytic agent used (67%), but only nine patients received the approved FDA regimen. With catheter-directed thrombolysis, low-dose thrombolytics and fragmentation were the most common regimens. Major bleeding occurred in 18% of cases, but there was no intracranial bleeding. One maternal death occurred secondary to refractory cardiogenic shock. Fetal mortality was 20%. During the immediate puerperium, nine patients received "off-label" first-, second-, and third-generation thrombolytic regimens, and four cases underwent catheter-directed thrombolysis. We observed nine major bleeding events, seven of which were from the uterine location and none of which were intracranial. In conclusion, overall, these data do not suggest prohibitive risk associated with thrombolysis for PE in pregnancy. Management of massive and high-risk submassive PE in pregnancy should be individualized to each patient. In the data presented, no fatal bleeding or intracranial bleeding was observed. Finally, future efforts should systematically collect and report data on high-risk PE in pregnancy and peripartum patients to improve the evidence-base clinical practice.
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Affiliation(s)
- David Rodriguez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico
| | - Carlos Jerjes-Sanchez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico.
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico.
- Hospital Zambrano Hellion, Batallón de San Patricio 112, Real San Agustin, San Pedro Garza Garcia, Nuevo Leon, 66278, Mexico.
| | - Sugely Fonseca
- Internal Medicine, Hospital San José, TecSalud, Nuevo Leon, Monterrey, Mexico
| | | | | | | | - Claudia Ortiz-Ledesma
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Francisco Nevarez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
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5
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Holland R, Houten JK, Elsamragy S, Kim J, Leyvi G, Kinon MD. Intraoperative Thrombolysis of Massive Pulmonary Embolus During Spine Surgery: Case Report of Survival Complicated by Massive Bleeding and Review of the Literature. World Neurosurg 2020; 146:59-63. [PMID: 33059081 DOI: 10.1016/j.wneu.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is a known risk of lumbar spinal fusion surgery that can lead to sudden and unexpected death. Treatment often involves systemic anticoagulation when the risk of potentially fatal hemodynamic deterioration is judged to outweigh the risk of epidural hematoma and paralysis. Acute massive PE with obstruction of more than 50% of the pulmonary arterial tree causes right heart failure, hypotension, and often rapid death, and may require aggressive medical intervention with thrombolytic agents, such as alteplase, although in the postoperative period this entails an extremely high risk of bleeding and the associated potential neurologic morbidity. CASE DESCRIPTION We report the first case, to our knowledge, of intraoperative thrombolytic therapy during spine surgery in a 68-year-old woman who developed a massive PE with cardiac arrest while undergoing lumbar instrumented fusion surgery in the prone position and detail the postoperative course that was complicated by severe bleeding. CONCLUSIONS Our experience is that chemical thrombolysis can be a lifesaving option to address pending circulatory arrest, but that severe bleeding is a likely consequence. If used to treat an intraoperative emergency, a smaller than standard dose of thrombolytic should be considered.
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Affiliation(s)
- Ryan Holland
- Leo M. Davidoff Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - John K Houten
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Maimonides Medical Center, Brooklyn, New York, USA
| | - Shahenaz Elsamragy
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jinu Kim
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Galina Leyvi
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Merritt D Kinon
- Leo M. Davidoff Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, USA
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6
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Taylor JEA, Ngua CW, Carwardine M. Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy. BMJ Case Rep 2020; 13:e234083. [PMID: 32327458 PMCID: PMC7202774 DOI: 10.1136/bcr-2019-234083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 11/03/2022] Open
Abstract
Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.
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Affiliation(s)
| | - Chen Wen Ngua
- Emergency Unit, University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Matthew Carwardine
- Anaesthetics, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, UK
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7
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Diagnosis and Thrombolytic Management of Massive Intraoperative Pulmonary Embolism Guided by Point of Care Transthoracic Echocardiography. Case Rep Anesthesiol 2018; 2018:8709026. [PMID: 29686907 PMCID: PMC5857334 DOI: 10.1155/2018/8709026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 01/27/2023] Open
Abstract
Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed.
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8
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Sousa Gomes M, Guimarães M, Montenegro N. Thrombolysis in pregnancy: a literature review. J Matern Fetal Neonatal Med 2018; 32:2418-2428. [DOI: 10.1080/14767058.2018.1434141] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marina Sousa Gomes
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
| | - Mariana Guimarães
- Department of Obstetrics and Gynecology, São João Hospital Center, Porto, Portugal
| | - Nuno Montenegro
- Department of Obstetrics and Gynecology, São João Hospital Center, Porto, Portugal
- Medicine Faculty, University of Porto, Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
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9
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Laher AE, Richards G. Cardiac arrest due to pulmonary embolism. Indian Heart J 2018; 70:731-735. [PMID: 30392514 PMCID: PMC6204441 DOI: 10.1016/j.ihj.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 01/21/2023] Open
Abstract
Pulmonary embolism (PE) is a potentially life threatening clinical condition that is fairly non-specific in presentation. Massive pulmonary embolism (PE) without cardiac arrest has been associated with a mortality rate of 30%. However, when cardiac arrest ensues, mortality may be as high as 95%. Since outcomes of cardiac arrest following PE are generally dismal, any available potentially life-saving measure must be instituted when the diagnosis of PE is suspected. Despite a lack of randomized controlled trials guiding the management of suspected PE in the cardiac arrest victim, thrombolysis and other therapies have been associated with good outcomes in the handful of published case reports and other small studies.
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Affiliation(s)
- Abdullah Ebrahim Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
| | - Guy Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
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10
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Tawfik M, Taman M, Tarbay A, Sayed M, Awad K. Circulatory collapse in a parturient undergoing cesarean delivery: a diagnostic dilemma. Int J Obstet Anesth 2017; 31:91-96. [DOI: 10.1016/j.ijoa.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/10/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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11
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Akazawa M, Nishida M. Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature. Acta Obstet Gynecol Scand 2017; 96:529-535. [PMID: 28222238 DOI: 10.1111/aogs.13116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 12/14/2022]
Abstract
Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery. Blood transfusion was necessary in all cases except for one (12/13; 92%). In seven cases (7/13; 54%), a large amount of blood was required for transfusion. Subsequent laparotomy to control bleeding was required in five cases (5/13; 38%), including three cases of hysterectomy and two cases of hematoma removal, all of which involved cesarean delivery. In cases of transvaginal delivery, there was no report of laparotomy. The occurrence of severe bleeding was high in relation to cesarean section, compared with vaginal deliveries. Using rt-PA in relation to cesarean section might be worth avoiding. However, the paucity of data in the literature makes it difficult to assess the ultimate outcomes and safety of this treatment.
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Affiliation(s)
- Munetoshi Akazawa
- Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Makoto Nishida
- Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan
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12
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The case of a successful cardiopulmonary resuscitation with using thrombolysis in massive pulmonary embolism in puerperant after cesarean section. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Yu Y, Zhai Z, Yang Y, Xie W, Wang C. Successful thrombolytic therapy of post-operative massive pulmonary embolism after ultralong cardiopulmonary resuscitation: a case report and review of literature. CLINICAL RESPIRATORY JOURNAL 2015; 11:383-390. [PMID: 26083151 DOI: 10.1111/crj.12332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/22/2015] [Accepted: 06/07/2015] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Yanxia Yu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Zhenguo Zhai
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,National Clinical Research Center of Respiratory Disease; China-Japan Friendship Hospital. Yinghua Dongjie, Hepingli Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Wanmu Xie
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Chen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,National Clinical Research Center of Respiratory Disease; China-Japan Friendship Hospital. Yinghua Dongjie, Hepingli Beijing, China
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14
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Aniskevich S, Ladlie BL, Pai SL, Perry DK, Canabal JM, Taner CB. Postoperative Stroke Following Administration of Intraoperative Recombinant Tissue Plasminogen Activator for the Treatment of Intracardiac Thrombus During Liver Transplantation. J Cardiothorac Vasc Anesth 2014; 29:1314-8. [PMID: 25440645 DOI: 10.1053/j.jvca.2014.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen Aniskevich
- Department of Anesthesiology, Division of Hepatobiliary and Solid Organ Transplant Anesthesiology, Mayo Clinic, Jacksonville, Florida.
| | - Beth L Ladlie
- Department of Anesthesiology, Division of Hepatobiliary and Solid Organ Transplant Anesthesiology, Mayo Clinic, Jacksonville, Florida
| | - Sher-Lu Pai
- Department of Anesthesiology, Division of Hepatobiliary and Solid Organ Transplant Anesthesiology, Mayo Clinic, Jacksonville, Florida
| | - Dana K Perry
- Department of Transplantation, Division of Transplant Surgery, Mayo Clinic, Jacksonville Florida
| | - Juan M Canabal
- Department of Transplantation, Division of Transplant Critical Care, Mayo Clinic, Jacksonville, Florida
| | - C Burcin Taner
- Department of Transplantation, Division of Transplant Surgery, Mayo Clinic, Jacksonville Florida
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15
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Shaulov T, David M, Pellerin M, Morin F. Massive Hemorrhage Following Thrombolysis for Postpartum Pulmonary Embolism With Cardiac Arrest. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:498-501. [DOI: 10.1016/s1701-2163(15)30563-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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16
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Condliffe R, Elliot CA, Hughes RJ, Hurdman J, Maclean RM, Sabroe I, van Veen JJ, Kiely DG. Management dilemmas in acute pulmonary embolism. Thorax 2013; 69:174-80. [PMID: 24343784 PMCID: PMC3913120 DOI: 10.1136/thoraxjnl-2013-204667] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, , Sheffield, UK
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17
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Choi SP, Wee JH, Park JH, Park KN, Hong SJ, Lee SH. Therapeutic hypothermia following emergent coronary artery bypass grafting after failed percutaneous coronary intervention in a comatose post-cardiac arrest patient. J Korean Med Sci 2013; 28:1257-9. [PMID: 23960458 PMCID: PMC3744719 DOI: 10.3346/jkms.2013.28.8.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
We report the case of 60-yr-old female in which therapeutic hypothermia (TH) was successfully induced maintaining the target temperature of 34℃ for 12 hr despite a risk of hypothermia-induced coagulation abnormalities following an emergent coronary artery bypass grafting (CABG) due to failed percutaneous coronary intervention, who suffered a cardiac arrest. Emergent CABG may be a relative contraindication for TH in post-cardiac arrest patients because hypothermia may increase the risk of infection and bleeding. However, the possibility of an improved neurologic outcome outweighs the risk of bleeding, although major surgery may be a relative contraindication for TH.
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Affiliation(s)
- Seung Pill Choi
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Wee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Jin Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Massive pulmonary embolism in a patient undergoing Cesarean delivery. J Clin Anesth 2012; 24:582-5. [DOI: 10.1016/j.jclinane.2012.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/15/2012] [Accepted: 03/11/2012] [Indexed: 11/21/2022]
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