Successful resuscitation with thrombolysis of a patient suffering fulminant pulmonary embolism after recent intracerebral haemorrhage.
We report the life-saving administration of thrombolysis during cardiopulmonary resuscitation in a patient with recent intracerebral haemorrhage. A 53-year-old male with intracerebral haemorrhage was admitted to the intensive care unit. On the 24th day of treatment he suffered cardiac arrest with pulseless electrical activity. Transoesophageal echocardiography was performed during ongoing cardiopulmonary resuscitation. Thrombi in the right heart cavities with excessive right ventricular dysfunction confirmed the diagnosis of fulminant pulmonary embolism. Permanent restoration of a spontaneous rhythm was feasible only after administration of systemic thrombolysis with recombinant tissue plasminogen activator. Neurological examination and a computed tomogram of the brain did not show rebleeding. We conclude that under extreme circumstances absolute contraindications to thrombolysis should be weighed against the potential benefit.
Koroneos
Apostolos
A
Department of Pulmonary and Critical Care Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece. KORONEOS@hotmail.com
Koutsoukou
Antonia
A
Zervakis
Dimitrios
D
Politis
Panagiotis
P
Sourlas
Sotiris
S
Pagoni
Eleni
E
Roussos
Charis
C
D000208:Acute Disease; D016887:Cardiopulmonary Resuscitation; D002543:Cerebral Hemorrhage / Q000150:complications*; D017548:Echocardiography, Transesophageal; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D010959:Tissue Plasminogen Activator