Is Thrombolytic Therapy Safe after CPR for Patients with Pulmonary Embolism?

Yıl 2020, Cilt: 2 Sayı: 3, 236 - 238, 15.12.2020

Ramazan Ünal , Ramazan Güven , Bensu Bulut , Kemal Biçer , Ertuğrul Ak , Basar Cander

Öz

Pulmonary embolism (PE) is a life threatening emergency condition. PE is considered in suspected patients referring due to syncope or shock. Trombolytic treatment may be started for the patients with higher risk for PE according to transthoracic echocardiography (TTE) results. An eighty-year old female patient was taken to the emergency service at an unconscious state by her relatives. No pulse was detected in the first assessment. Cardiopulmonary resuscitation (CPR) was started. Return of spontaneous circulation (ROSC) was achieved at 15th minute of the CPR. TTE revealed dilation in the right ventricle and lower pressure in the left ventricle. There as not any risk factor for pulmonary embolism in preliminary diagnosis. The unstable patient was referred to CT angiography with emergency medicine physician. An image consistent with embolism in both branches of the pulmonary artery was detected in CT angiography and trombolytic treament was started. The patient was admitted to intensive care unit of the emergency service. Thrombolytic treatment may be implemented for high-risk patients for PE and in the patients who achieved return of spontaneous circulation after cardiac arrest. Furthermore, such interventions were detected to be life saving.

Anahtar Kelimeler

pulmonary embolism, , bedside transthoracic echocardiography, thrombolytic therapy

Kaynakça

• Referans1. Kourkouta, Lambrini & Konstantinos, Koukourikos & Christos, Iliadis & Petros, Ouzounakis & Areti, Tsaloglidou. (2018). Pulmonary Embolism: A Literature Review. 10.11648/j.ajns.s.2018070301.19.
• Referans2. Duru, Serap, et al. "Pulmoner embolide klinik, laboratuvar ve bilgisayarlı tomografi pulmoner anjiyografi sonuçları: 205 hastanın retrospektif değerlendirmesi." Anadolu Kardiyol Derg 12 (2012): 142-9.
• Referans3. Bĕlohlávek, Jan, Vladimír Dytrych, and Aleš Linhart. "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism." Experimental & Clinical Cardiology 18.2 (2013): 129.
• Referans4. Moore, Alastair JE, et al. "Imaging of acute pulmonary embolism: an update." Cardiovascular diagnosis and therapy 8.3 (2018): 225.
• Referans5. Authors/Task Force Members, et al. "2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS)." European heart journal 35.43 (2014): 3033-73.
• Referans6. Yin, Qin, Xiao Li, and Chunsheng Li. "Thrombolysis after initially unsuccessful cardiopulmonary resuscitation in presumed pulmonary embolism." The American journal of emergency medicine 33.1 (2015): 132-e1.
• Referans7. Wu, Jiang-Ping, et al. "Good neurological recovery after rescue thrombolysis of presumed pulmonary embolism despite prior 100 minutes CPR." Journal of thoracic disease 6.12 (2014): E289.
• Referans8. Yamamoto, Takeshi. "Management of patients with high-risk pulmonary embolism: a narrative review." Journal of intensive care 6.1 (2018): 16.
• Referans9. Aliyev, Dostali, Cihan Şahin, and Onur Özlü. "Masif Pulmoner Emboliye Bağlı Kardiyak Arrest ve Başarılı Sistemik Tromboliz."
• Referans10. Jiang-Ping Wu, Dan-Yan Gu, Sheng Wang, Zhen-Jun Zhang, Jian-Cang Zhou and Rui-Feng Zhang "A meta-analysis of cardiopulmonary resuscitation with and without the administration of thrombolytic agents." Resuscitation 70.1 (2006): 31-36.
• Referans11. Beydilli İ, Yılmaz F, Sönmez BM, Kozacı N, Yılmaz A, Toksul İH, et al "Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service." The Kaohsiung journal of medical sciences 32.11 (2016): 572-78.