Low-dose tenecteplase during cardiopulmonary resuscitation due to massive pulmonary embolism: a case report and review of previously reported cases

Abstract

The case of a 29 year-old man who suffered a cardiac arrest due to a massive pulmonary embolism while he was undergoing surgical repair of a complex tibial plateau fracture is presented. After 70 min of unsuccessful cardiopulmonary resuscitation a bolus of 20 mg tenecteplase was given, with a return of spontaneous circulation 2 min after administration of the drug. Pulmonary embolism was subsequently demonstrated on a pulmonary angiogram. To our knowledge this is the first report to show that the use of a low dose of tenecteplase might be useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive pulmonary embolism. Previously reported cases are reviewed.

Caught in the Clot: A Case Report of Arrested Pulmonary Embolism

“…Alteplase is the only Food and Drug Administration-approved drug for systemic fibrinolysis in the case of PE. However, success with other thrombolytic agents (tenecteplase) has been described in one study [ 18 ]. Scholz et al noted that seven out of 17 (41%) patients who received thrombolytic treatment during cardiac arrest after PE had favorable outcomes [ 19 ], and Hopf et al showed similar results in five out of six patients [ 20 ].…”

Cardiac arrest due to pulmonary embolism

“…Renkes-Hegendörfer and Hermann were amongst the first to describe a case of a successful outcome after administering streptokinase to a patient in cardiac arrest due to PE 47 . Subsequently success with other thrombolytic agents including urokinase, 48 rt-PA (alteplase), 49 reteplase 50 and tenecteplase 51 have also been described 45 . In a retrospective comparative study of patients that received fibrinolytic therapy with rt-PA during cardiac arrest due to PE, significantly better outcomes with regards ROSC (67% vs 43%), 24 h survival (53% vs 23%) and hospital discharge (19% vs 7%) were achieved in the group that received thrombolysis 52 …”