Thrombolytic Use During Cardiopulmonary Arrest in Massive Pulmonary Embolism: Return to Life of Two Patients

The diagnosis of pulmonary embolism is still difficult, because it may occur with different symptoms and signs. These cases can be admitted to the emergency department with shock, syncope or cardiopulmonary arrest. More than 70 percent of cardiopulmonary arrest cases are caused by acute myocardial infarction or massive pulmonary embolism and it has a poor prognosis. We present two cases of massive pulmonary embolism requiring cardiopulmonary resuscitation and administered thrombolytic agents. Two patients received 10 mg bolus of recombinant tissue-type plasminogen activator (alteplase) followed by 90 mg intravenous infusion for two hours. Rapid clinical and hemodynamic improvement occurred after thrombolytic injection and the patients were discharged from the hospital. In case of suspicion of massive pulmonary embolism in cardiopulmonary arrest cases, thrombolytic agents should be administered during cardiopulmonary resuscitation. This procedure will treat the condition caused by arrest and also is shown to have beneficial effects on the early microcirculatory cerebral reperfusion and to prevent neurological sequelae.