Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism.
Pulmonary thromboembolism has an incidence of more than 69/100 000 population but may be underdiagnosed because of the non-specific character of its symptoms and difficult differential diagnosis. The prognosis is worse if the pulmonary thromboembolism is massive and associated with haemodynamic instability, whereupon mortality rises to over 50%. Cardiogenic shock supervenes and cardiopulmonary arrest is often inevitable. This emergency can only be prevented by aggressive therapy with thrombolytic agents. The case history is described of a 25-year-old woman in cardiogenic shock leading to prehospital cardiac arrest in which intravenous access was impossible. Resuscitation drugs were given by the intraosseous route and, with a suspected diagnosis of massive pulmonary thromboembolism, it was decided to start thrombolysis by the same route before transport to hospital. The treatment was a complete success, and the patient was discharged from hospital with no sequelae after 39 days.
Anaesthetic Department MP 25, Royal Hampshire County Hospital, Winchester, UK.
Mario
M
Valdés
Pilar
P
Araujo
Carmen
C
de Andrés
Eva
E
Sastre
Terence
T
Martin
D000328:Adult; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D017148:Infusions, Intraosseous; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed