Sudden cardiac arrest caused by pulmonary embolism (PE) is highly refractory to conventional cardiopulmonary resuscitation (CPR). Systemic thrombolytic therapy has been shown useful for return of spontaneous circulation on patient resuscitation. Nevertheless, thrombolysis during CPR is still controversial due to the risks of severe bleeding complications. While the work-up for securing PE diagnosis can delay therapy initiation, thrombolysis should be administered as early as possible when it is considered during CPR. Thus, in selected cases presenting features highly indicative of PE, the pragmatic initiation of thrombolysis under ongoing CPR could significantly improve the patient outcome.
Key Words
Cardiopulmonary arrest, cardiopulmonary resuscitation, pulmonary embolism, alteplase, thrombolytic therapy
What is already known about the topic?
- Cardiac arrest due to pulmonary embolism bears a high mortality and morbidity rate.
- The initiation of thrombolysis can be delayed by the work-up for confirming PE.
- A prompt diagnosis of PE is critical, as thrombolytic therapy initiation may significantly improve patient outcome.
What does this article bring up for us?
- The article highlights the need to quickly identify the features associated with a high likelihood of PE at the origin of cardiac arrest.
- In certain emergency cases, the clinician must correctly identify patients with a high clinical probability of PE and optimize the risk-benefit ratio of initiating systemic thrombolysis for managing PE-related cardiac arrest.
- The clinician must select an appropriate thrombolytic agent and dosing protocol.