[Successful treatment of a fulminant pulmonary embolism using a high-dose bolus injection of urokinase during cardiopulmonary resuscitation].

Experience has shown that the bolus injection of streptokinase during resuscitation in case of fulminant pulmonary embolism considerably improves the prognosis. In the case presented here a 64-year old female patient with a fulminant pulmonary embolism was injected with 2 x 1,000,000 I.U. urokinase after 20 minutes of unsuccessful cardiopulmonary resuscitation. Ten minutes after the second injection the circulation could be stabilised by drugs only. The patient survived without any lasting damage. The mechanism of fibrinolysis during resuscitation is discussed. It is also possible to check the diagnosis during resuscitation using echocardiography or angiography. However, treatment must usually start immediately only on clinical diagnosis. Resuscitation in the case of a pulmonary embolism can even be successful after much longer than one hour. Contra-indications must be ignored in such cases. Side effects, which are usually haemorrhages, can as a rule be treated. In our opinion urokinase should be given by preference in the bolus injection during resuscitation. The exception to this is the primary operation during resuscitation. Pulmonary embolectomy is also possible after unsuccessful fibrinolysis.