Neurologically normal survival after fibrinolysis during prolonged cardiac arrest: case report and discussion

Abstract

Cardiac arrest secondary to pulmonary embolism is a devastating condition with a high mortality rate. It is currently unclear whether fibrinolysis (thrombolysis) is beneficial in this setting. We report the case of a 28-year-old woman with a pulmonary embolism who developed return of pulses following the administration of tissue plasminogen activator after 38 minutes of pulseless electrical activity cardiac arrest. She went on to make a full neurologic and cardiopulmonary recovery. This case is discussed with reference to the current literature on the subject. RÉSUMÉ L'arrêt cardiaque découlant de l'embolie pulmonaire est une affection dévastatrice associée à un taux élevé de mortalité. Actuellement, les bienfaits de la fibrinolyse (thrombolyse) n'ont pas été déterminés avec certitude dans un tel contexte. Nous présentons le cas d'une femme âgée de 28 ans atteinte d'une embolie pulmonaire dont le pouls est revenu après l'administration d'un activateur tissulaire du plasminogène. Elle avait été en arrêt cardiaque avec activité électrique sans pouls pendant 38 minutes. Elle a par la suite connu une récupération neurologique et cardio-pulmonaire complète. Ce cas est discuté dans le cadre de la littérature présentement disponible sur le sujet.

Successful Alteplase Bolus Administration for a Presumed Massive Pulmonary Embolism During Cardiopulmonary Resuscitation

“…3 Published cases revealed good or intact neurological status for the majority of survivors, even in cases of prolonged CPR up to 90 minutes and delayed fibrinolytic administration up to 60 minutes. 4,14,15,[18][19][20][21][23][24][25][27][28][29]33,35,37 These findings are consistent with experimental studies that showed that fibrinolytics may reduce the cerebral no-reflow phenomenon and improve microcirculatory reperfusion. 40,41 The occurrence of major bleeding complications (total, intracranial, and fatal) is a serious concern of fibrinolysis during CPR.…”

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

“…2 It is impossible to know if the thrombolytic agent played a role in our patient's outcome; however, two randomized controlled trials have shown that thrombolysis during CPR is not beneficial in an undifferentiated population. 3,4 What is noteworthy about our case is the use of ECMO and the probable role it played.…”