Biography
Biography: Mehmet Hüsamettin AKKÜÇÜK
Abstract
Objective: Describing a case of a patient with presumed massive pulmonary embolism with
cardiac arrest and successfull resuscitation with fibrinolysis during CPR using rTPA.
Case summary: A 74-year-old man presented to the emergency departme for head trauma
due to syncope. On arrival, initial examination was suspect for myocardial infarction, and
cardiogenic shock but there were no signs of pulmonary overload. Cardiac ECHO showed a
dilated right heart and additional analysis turned the differential diagnosis to pulmonary
embolism.. Thrombolytic therapy was considered. His condition rapidly deteriorated and
progressed to cardiopulmonary arrest.During advanced cardiac life support, empirical
alteplase 50 mg was administered intravenously over 15 minutes with return of spontaneous
circulation (ROSC) The diagnosis of massive PE using computed tomography angiography
was confirmed after fibrinolytic therapy. During hospitalisation gastrointestinal bleeding
developed requiring transfusion, but no further complications occurred. Patient was
discharged after 15 days without any neurological sequelae.
Discussion: Diagnosing pulmonary embolism may be difficult. Massive pulmonary embolism
has a high mortality and early treatment is essential. Return of spontaneous circulation
(ROSC) is very rare in patients with cardiac arrest following massive PE. Clinical guidelines
recommend fibrinolytic therapy for patients with PE and cardiac arrest. It has classically been
contraindicated because of a concern for fatal bleeding. Current literature based on
retrospective studies and case reports however, seems to favor fibrinolytic treatment in PEassociated
cardiac arrest due to an increased chance of ROSC and improved survival.
CONCLUSION: Fibrinolysis may be beneficial in achieving ROSC, reducing mortality, and
preserving neurological function in PE-associated cardiac arrest patients, even in cases of
prolonged CPR and delayed fibrinolytic administration without increased risk