Massive pulmonary embolism and cardiac arrest; thrombolytic therapy in a patient with recent intracranial surgery and glioblastoma multiforme

• Published in: The American journal of emergency medicine Vol. 32; no. 11; pp. 1441.e1 - 1441.e3
• Main Authors: Bayram, Başak, MD, Oray, Neşe Çolak, MD, Korkmaz, Emel, MD, Erdost, Hale Aksu, MD, Gokmen, Necati, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014; Elsevier Limited
• Subjects: Brain Neoplasms - surgery; Cardiopulmonary Resuscitation; Catheters; CPR; Emergency; Emergency medical care; Fibrinolytic Agents - therapeutic use; Glioblastoma - surgery; Heart Arrest - etiology; Heart Arrest - therapy; Heart attacks; Hospitals; Humans; Male; Middle Aged; Mortality; Pulmonary Embolism - drug therapy; Pulmonary Embolism - etiology; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - therapeutic use
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.04.022

Treatment options for pulmonary embolism are increasing, but the scale of the treatments and their availability in the emergency department (ED) are limited. Thrombolytic therapy remains the most commonly used treatment in patients who present a massive pulmonary embolism in the ED. However, systemic thrombolysis is contraindicated in certain cases, such as a known intracranial tumor or a history of cranial surgery.In this case report, we report a 63-year-old man with a history of intracranial surgery due to glioblastoma multiforme 20 days prior to being admitted to the ED. Multidetector-row computed tomography angiography revealed embolisms in both main pulmonary arteries.There was a progression of cardiac arrest while preparing for catheterization; thus, cardiopulmonary resuscitation was initiated.After administering 10 minutes of cardiopulmonary resuscitation, a50-mg alteplase bolus was given. Within minutes, a pulse has returned. No complications associated with the thrombolytic therapy were observed.Our aim was to discuss the management of massive pulmonary embolism with a contraindication to systemic thrombolytic therapy.