Case report: From echocardiography to fibrinolysis. The role of ultrasound in the suspect and management of massive pulmonary thromboembolism after cardiopulmonary arrest
DOI:
https://doi.org/10.62059/tvkk5y56Keywords:
Massive pulmonary embolism, Cardiac arrest, Point-of-care echocardiography, FibrinolysisAbstract
Massive pulmonary embolism (PE) complicated with cardiac arrest (CA) has high mortality. Point-of-care echocardiography (POCUS) enables rapid diagnosis. We present a unique case of an elderly patient with comorbidities and recent surgery, in whom POCUS guided fibrinolysis during resuscitation. A 79-year-old woman, post-hemorrhoidectomy, presented with chest pain, syncope, and two CA episodes. On ICU admission, she had Glasgow 5/15, obstructive shock, lactate >10 mmol/L, elevated D-dimer, and positive troponin. POCUS revealed severe right chamber dilation, positive McConnell's sign, and RV/LV ratio >1. Massive PE was diagnosed. Despite recent surgery, tenecteplase 45 mg was administered. At 8 hours, echocardiography showed improved right ventricular function. She was extubated on day 4, and by day 11 she had Glasgow 15/15, with PE resolution confirmed by CT angiography. POCUS is essential for PE diagnosis during CA. Rescue fibrinolysis can be life-saving even with recent surgery, and complete neurological recovery is achievable with early reperfusion.References
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