title: Prolonged chest compressions during cardiopulmonary resuscitation for in-hospital cardiac arrest due to acute pulmonary embolism.
abstract: Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal prognosis if not treated rapidly. Therapeutic options include systemic thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However, the efficacy of thrombolytic therapy is diminished because the low-output state hinders effective delivery of the lytic agent to the thrombus. In the absence of any form of mechanical circulatory support, such as extracorporeal membrane oxygenation or cardiac surgery on site, we think that prolonged vigorous manual compressions might be the only way to support the circulation during the initial critical state, when thrombolytic therapy has been administered. We report the results of prolonged manual chest compressions (exceeding 30 minutes) on 6 patients who received tenecteplase in treatment of acute pulmonary embolism that induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were discharged from the hospital. In an era of increasing technologic complexity for patients with hemodynamic instability, we emphasize the importance of prolonged chest compressions, which can improve systemic perfusion, counteract the prothrombotic state associated with cardiopulmonary arrest, and give the lytic agent time to act.
authors: Carla
authors: C
authors: Nobre
authors: Boban
authors: B
authors: Thomas
authors: Luis
authors: L
authors: Santos
authors: João
authors: J
authors: Tavares
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D016757:Death, Sudden, Cardiac; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D012189:Retrospective Studies
keywords: Cardiopulmonary arrest/therapy; cardiopulmonary resuscitation; manual compressions, prolonged; pulmonary embolism, acute/therapy; retrospective studies; tenecteplase; thrombolytic therapy; tissue plasminogen activator/therapeutic use