Complication of intraosseous administration of systemic fibrinolysis for a massive pulmonary embolism with cardiac arrest

Successful Intraosseous Thrombolysis in the Management of a Massive Pulmonary Embolism With Cardiac Arrest

“…This case lends further weight to suggesting that the administration of thrombolysis during cardiac arrest via the IO route is safe where venous access is difficult [14,15]. Whilst there are potential risks of inducing hemorrhage, air emboli, fractures, and tissue necrosis [16], it was felt that the potential benefits outweighed the risks of administration in this critically unwell patient. She did not suffer any bleeding or neurovascular complications as a result.…”

Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism

“…There are two descriptions of massive PE management with intraosseous thrombolysis. [ 3 5 ] In both cases, tissue plasminogen activator, administered as a weight-adjusted bolus, provided adequate thrombolytic therapy. Intraosseous thrombolysis has also been reported in the setting of acute ST-segment elevation myocardial infarction.…”

“…Complications of intraosseous infusions include needle displacement, bone fracture, extravasation of the infusion, compartment syndrome, osteomyelitis and fat embolism. [ 7 ] In the case described by Landy et al .,[ 5 ] treatment was complicated by tissue necrosis around the site of intraosseous needle. The risk of local hemorrhage and compartment syndrome is increased with the administration of thrombolytic therapy, however, this was not observed in our patient.…”

“…There are three previous reports of successful intraosseous thrombolysis, with two being in the setting of PE. [ 3 4 5 ] There have been no previous reports of intraosseous thrombolysis in combination with ECMO therapy for massive PE.…”

Erkannt und konsequent erfolgreich behandelt: Reanimation bei Lungenarterienembolie

“…Bei schlechten Venenverhältnissen und unsicherem PVK erfolgte aus Mangel an Alternativen die Anlage eines intraossären Zugangs (IO-Zugang), über welchen auch die Lyse appliziert worden ist. Obwohl Komplikationen nach intraossären Zugangsanlagen sehr selten sind und in diesem Fall auch nicht auftraten, sollte man mögliche Risiken bedenken: Landy berichtete 2012 in einem Fallbericht von ausgeprägten Nekrosen im Bereich der Insertionsstelle nach Lysetherapie über einen IO-Zugang [7]. Die linke Tibia wurde im berichteten Fall für den IO-Zugang verwendet, da sich lokal keine Kontraindikation wie Rötung oder Überwärmung zeigten.…”