Analysis Of The Early Diagnosis And Thrombolytic Therapy In Patients Of The Acute Fatal Pulmonary Embolism

Objective:To analyze the clinical characteristics of the thrombolytic therapy for treating acute fatal pulmonary embolism (FPE) during or after cardiopulmonary resuscitation (CPR), to discuss the early diagnosis and timely treatments of FPE in order to reduce its mortality.Methods:A retrospective evaluation was conducted on 5 patients with cardiac arrest caused by acute fatal pulmonary embolism from 2012.6 to 2015.11 in Sir Run Run Shaw Hospital, focused on the risk factors, clinical features, laboratory tests and biomarkers, electrocardiogram, echocardiography, lower limb compression venous ultrasonography, computed tomographic pulmonary arteriography (CTPA), diagnosis time, therapy and outcome.Results:All 5 cases had risk factors. The main clinical features included syncope, dyspnea and sweating. Physical examination showed tachycardia and tachypnea. Electrocardiogram could find sinus tachycardia and ST-T segment changes. Cardiac arrest from pulmonary embolism presented as any rhythm, such as pulseless electrical activity (PEA), asystole, sinus tachycardia and so on. Echocardiography showed right ventricular dilatation, pulmonary hypertension, and tricuspid regurgitation. All of them received thrombolytic therapy during or after CPR.3 of these cases confirmed of FPE by CTPA showing at least segmental PE.1 of these cases confirmed by lower limb venous ultrasonography showing proximal deep venous thrombosis.4 of them successfully rescued, and one died.Conclusions:Patients with risk factors for pulmonary embolism should be highly suspected to have FPE-induced cardiac arrest.We suggest that thrombolysis should be considered in patients who are highly suspected to have PE-induced cardiac arrest, particularly if the arrest rhythm is PEA, and echocardiographic signs of right ventricular overload, ultrasonographic findings of proximal deep venous thrombosis during CPR.To FPE, rt-PA 50mg has been commonly used as a standard for thrombolytic therapy, but we should select appropriate patients with the optimizing rt-PA dosing.