Yuan GX, Zhang ZP, Zhou J. Thrombolysis and extracorporeal cardiopulmonary resuscitation for cardiac arrest due to pulmonary embolism: A case report. World J Crit Care Med 2025; 14(1): 97443 [DOI: 10.5492/wjccm.v14.i1.97443]
Corresponding Author of This Article
Zhi-Ping Zhang, MD, Chief Doctor, Department of Emergency, Wuhan Asia General Hospital, No. 300 TaZi Hu North Road, Economic and Technological Development Zone, Wuhan 430056, Hubei Province, China. blyynk@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Mar 9, 2025; 14(1): 97443 Published online Mar 9, 2025. doi: 10.5492/wjccm.v14.i1.97443
Thrombolysis and extracorporeal cardiopulmonary resuscitation for cardiac arrest due to pulmonary embolism: A case report
Guan-Xing Yuan, Zhi-Ping Zhang, Jia Zhou
Guan-Xing Yuan, Zhi-Ping Zhang, Department of Emergency, Wuhan Asia General Hospital, Wuhan 430056, Hubei Province, China
Jia Zhou, Department of Neurosurgery, Central Theater Command General Hospital, Wuhan 430000, Hubei Province, China
Author contributions: Yuan GX, Zhang ZP, and Zhou J contributed to the conceptualization of this case report; Yuan GX and Zhang ZP were involved in the writing and preparation of the original draft; Zhou J contributed to the reviewing and editing of the manuscript. All authors have read and approved the final manuscript
Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China, No.WX23B42.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016) guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Ping Zhang, MD, Chief Doctor, Department of Emergency, Wuhan Asia General Hospital, No. 300 TaZi Hu North Road, Economic and Technological Development Zone, Wuhan 430056, Hubei Province, China. blyynk@hotmail.com
Received: May 30, 2024 Revised: October 6, 2024 Accepted: November 20, 2024 Published online: March 9, 2025 Processing time: 195 Days and 2.1 Hours
Abstract
BACKGROUND
Cardiac arrest caused by acute pulmonary embolism (PE) is the most serious clinical circumstance, necessitating rapid identification, immediate cardiopulmonary resuscitation (CPR), and systemic thrombolytic therapy. Extracorporeal CPR (ECPR) is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.
CASE SUMMARY
We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity. Upon arrival at the emergency department with ongoing manual chest compressions, bedside point-of-care ultrasound revealed an enlarged right ventricle without contractility. Acute PE was suspected as the cause of cardiac arrest, and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions. Despite 31 minutes of CPR, return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation (ECMO) support. Under ECMO support, the hemodynamic status and myocardial contractility significantly improved. However, the patient ultimately did not survive due to intracerebral hemorrhagic complications, leading to death a few days later in the hospital.
CONCLUSION
This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE, but it also highlights the increased risk of significant bleeding complications, including fatal intracranial hemorrhage.
Core Tip: This case study evaluates the feasibility of combining systemic thrombolysis with extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest due to acute pulmonary embolism. Despite hemodynamic and contractility improvements post-treatment with tissue plasminogen activator, the patient succumbed to intracerebral hemorrhagic complications. It underscores the potential of this combined approach but highlights the increased risk of severe bleeding, including fatal intracranial hemorrhage.
