title: Successful thrombolytic therapy of post-operative massive pulmonary embolism after ultralong cardiopulmonary resuscitation: a case report and review of literature.
abstract: OBJECTIVE
  Cardiac arrest caused by massive pulmonary embolism (PE) is highly refractory to conventional resuscitation. Thrombolytic therapy has been considered to be an effective way to massive PE.
  
  
  METHODS
  We reported a case of successful thrombolytic therapy of post-operative massive PE after 90-min cardiopulmonary resuscitation (CPR) and reviewed the relevant literature.
  
  
  RESULTS
  We presented the case of a 48-year-old woman with surgery of varicosis of great saphenous vein who suffered from a massive PE with circulatory arrest refractory to 90 min of aggressive CPR. Thrombolysis was given only as a single dose of 50 mg of recombinant tissue plasminogen activator. Rapid haemodynamic and clinical improvement followed the bolus dose. The patient was discharged later without neurological or other sequelae. An extensive literature search of the PubMed database only identified 11 cases of massive PE with cardiac arrest during the perioperative period with a survival rate was 88.9%. The time period of CPR before thrombolysis or anti-coagulation was 15-90 min.
  
  
  CONCLUSIONS
  Thrombolytic therapy is useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive PE during the perioperative period, even in the prolong resuscitation.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.|National Clinical Research Center of Respiratory Disease; China-Japan Friendship Hospital. Yinghua Dongjie, Hepingli Beijing, China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhai
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.
authors.forename: Yuanhua
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.
authors.forename: Wanmu
authors.initials: W
authors.lastname: Xie
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.|National Clinical Research Center of Respiratory Disease; China-Japan Friendship Hospital. Yinghua Dongjie, Hepingli Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D006323:Heart Arrest / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011994:Recombinant Proteins; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: cardiac arrest; cardiopulmonary resuscitation; massive pulmonary embolism; surgery; thrombolytic therapy