Successful resuscitation after bolus injection of tissue-type plasminogen activator in the emergency room

We report on a 30-year old female patient with suspected fulminant pulmonary embolism and cardiac arrest following ambulatory arthroscopy nine days before the event. After 15 minutes of unsuccessful cardiopulmonary resuscitation (CPR) on the ambulance the patient was transferred to the emergency unit of a hospital and was treated with bolus injection of 50 mg t-PA initially and 50 mg over the next two hours. Five minutes after the initial bolus the circulation could be stabilised and the patient could be extubated the next morning. The patient did not present any neurological deficit on the day of discharge nor did she show any bleeding complications. The time elapsing from notice to emergency service to arrival at hospital was about 35 minutes. Discussion: In patients with massive and life-threatening pulmonary embolism thrombolysis offers an opportunity to manage this critical situation. Due to the serious prognosis of these patients the potential benefit of thrombolysis outweighs the lack of preceding diagnostic procedures and the risk of potential side-effects. Conclusion: In the light of an excellent outcome of this patient thrombolytic therapy with t-PA appears to be justified under continued CPR if fulminant pulmonary embolism is suspected [1].