Koroneos Apostolos, Koutsoukou Antonia, Zervakis Dimitrios, Politis Panagiotis, Sourlas Sotiris, Pagoni Eleni, Roussos Charis
Department of Pulmonary and Critical Care Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
Resuscitation. 2007 Jan;72(1):154-7. doi: 10.1016/j.resuscitation.2006.06.019. Epub 2006 Nov 2.
We report the life-saving administration of thrombolysis during cardiopulmonary resuscitation in a patient with recent intracerebral haemorrhage. A 53-year-old male with intracerebral haemorrhage was admitted to the intensive care unit. On the 24th day of treatment he suffered cardiac arrest with pulseless electrical activity. Transoesophageal echocardiography was performed during ongoing cardiopulmonary resuscitation. Thrombi in the right heart cavities with excessive right ventricular dysfunction confirmed the diagnosis of fulminant pulmonary embolism. Permanent restoration of a spontaneous rhythm was feasible only after administration of systemic thrombolysis with recombinant tissue plasminogen activator. Neurological examination and a computed tomogram of the brain did not show rebleeding. We conclude that under extreme circumstances absolute contraindications to thrombolysis should be weighed against the potential benefit.
我们报告了一例近期发生脑出血的患者在心肺复苏期间进行溶栓挽救生命的情况。一名患有脑出血的53岁男性被收入重症监护病房。在治疗的第24天，他发生心脏骤停，出现无脉电活动。在持续心肺复苏期间进行了经食管超声心动图检查。右心腔内的血栓以及严重的右心室功能障碍证实了暴发性肺栓塞的诊断。仅在使用重组组织型纤溶酶原激活剂进行全身溶栓后，才实现了自主心律的永久恢复。神经学检查和脑部计算机断层扫描未显示再出血。我们得出结论，在极端情况下，应权衡溶栓的绝对禁忌症与潜在益处。
