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2015 ; 42
(2
): 136-8
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gab.com Text
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Prolonged chest compressions during cardiopulmonary resuscitation for in-hospital
cardiac arrest due to acute pulmonary embolism
#MMPMID25873823
Nobre C
; Thomas B
; Santos L
; Tavares J
Tex Heart Inst J
2015[Apr]; 42
(2
): 136-8
PMID25873823
show ga
Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal
prognosis if not treated rapidly. Therapeutic options include systemic
thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However,
the efficacy of thrombolytic therapy is diminished because the low-output state
hinders effective delivery of the lytic agent to the thrombus. In the absence of
any form of mechanical circulatory support, such as extracorporeal membrane
oxygenation or cardiac surgery on site, we think that prolonged vigorous manual
compressions might be the only way to support the circulation during the initial
critical state, when thrombolytic therapy has been administered. We report the
results of prolonged manual chest compressions (exceeding 30 minutes) on 6
patients who received tenecteplase in treatment of acute pulmonary embolism that
induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were
discharged from the hospital. In an era of increasing technologic complexity for
patients with hemodynamic instability, we emphasize the importance of prolonged
chest compressions, which can improve systemic perfusion, counteract the
prothrombotic state associated with cardiopulmonary arrest, and give the lytic
agent time to act.