Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report

Patient: Female, 66-year-old Final Diagnosis: Pulmonary embolism Symptoms: Cardiac arrest Medication: — Clinical Procedure: Thrombolytic therapy Specialty: Critical Care Medicine OBJECTIVE: Rare disease BACKGROUND: Approximately 290 000 cases of in-hospital cardiac arrest occur annually, the majority of which are due to cardiac or respiratory causes. Cardiac arrest due to acute pulmonary embolism (PE) is associated with a 90% incidence of mortality and, if identified, it can be treated with systemic thrombolytics. Here, we describe a case in which the outcome for such an event was favorable. CASE REPORT: A 66-year-old woman was admitted with multiple rib and left ankle fractures due to accidental trauma. Before undergoing orthopedic surgery, she experienced a cardiac arrest with pulseless electrical activity, which was witnessed. She had refractory hypoxia and hypotension following intubation and a brief initial return of spontaneous circulation (ROSC) before a second cardiac arrest. A 100-mg bolus dose of systemic thrombolytic therapy was promptly administered, with rapid achievement of sustained ROSC. The results of a subsequent electrocardiogram, echocardiogram, and computed tomography scan further supported the diagnosis of acute PE with right heart strain. Supportive care in the Intensive Care Unit resulted in full neurological recovery and she was discharged to a physical rehabilitation facility 12 days after her cardiac arrest. CONCLUSIONS: Systemic thrombolytic therapy is beneficial for cardiac arrest due to acute PE.