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

Area of Science:

• Cardiology
• Emergency Medicine
• Pulmonology

Background:

• In-hospital cardiac arrest affects approximately 290,000 individuals annually, primarily from cardiac or respiratory issues.
• Acute pulmonary embolism (PE) carries a high mortality rate (90%) but is treatable with systemic thrombolytics if diagnosed.
• This case highlights a favorable outcome in a patient with cardiac arrest secondary to acute PE.

Observation:

• A 66-year-old female patient experienced witnessed cardiac arrest with pulseless electrical activity during hospitalization for fractures.
• She developed refractory hypoxia and hypotension post-intubation, followed by a second cardiac arrest after initial return of spontaneous circulation (ROSC).

Findings:

• Prompt administration of a 100-mg systemic thrombolytic bolus resulted in sustained ROSC.
• Diagnostic tests including ECG, echocardiogram, and CT scan confirmed acute PE with right heart strain.
• The patient achieved full neurological recovery and was discharged 12 days post-cardiac arrest.

Implications:

• Systemic thrombolytic therapy demonstrates significant benefit in managing cardiac arrest caused by acute PE.
• Early identification and treatment are crucial for improving survival rates in these critical cases.
• This case underscores the potential for positive outcomes even in severe presentations of PE-induced cardiac arrest.