Department of Emergency Medicine and Intensive Care, Timone University Hospital, Marseille, France.
Am J Emerg Med. 2012 Jul;30(6):1015.e1-2. doi: 10.1016/j.ajem.2011.04.016. Epub 2011 Jun 23.
Pulmonary embolism (PE) is a common cause of sudden death; the use of prehospital thrombolysis is currently a last-resort option and requires a prolonged cardiopulmonary resuscitation (CPR). Novel mechanical devices have recently been introduced that provides automatic mechanical chest compression (AMCC) according to the guidelines and continually without decrease efficiency throughout prolonged resuscitation. A 54 year-old woman with a history of breast cancer experienced sudden chest pain and severe dyspnea. A mobile intensive care unit was dispatched to her home. During physical examination, she suddenly collapsed with pulseless electrical activity as the initial rhythm. Prehospital thrombolysis during CPR combined with use of AMCC was performed based on a strongly suspected diagnosis of massive PE. After 75 minutes of effective CPR, return of spontaneous circulation was attained. After admission to an intensive care unit, computed tomographic scan confirmed bilateral PE. The patient was discharged 3 weeks after CPR in good neurologic condition. To our knowledge, this is the first case describing combined use of thrombolysis and AMCC in out-ofhospital cardiac arrest. However, for the time being, prehospital thrombolysis in CPR continues to be a measure that should only be performed on a case-by-case basis based on informed decision. Further studies are needed to evaluate the efficacy and safety of AMCC with thrombolysis and thus prolonged CPR.
肺栓塞（PE）是导致猝死的常见原因之一；目前，院前溶栓治疗是一种最后的选择，需要进行长时间的心肺复苏（CPR）。最近引入了新型机械装置，可根据指南自动进行机械性胸部按压（AMCC），并在长时间的复苏过程中持续不断地保持高效率，而不会出现效率下降的情况。一位 54 岁的女性，有乳腺癌病史，突然出现胸痛和严重呼吸困难。一辆移动重症监护单元被派往她的家中。在体格检查过程中，她突然出现无脉性电活动，这是最初的节律。根据高度疑似的大面积 PE 诊断，在 CPR 期间进行了溶栓治疗，并结合使用 AMCC。在 75 分钟有效的 CPR 后，恢复了自主循环。入住重症监护病房后，计算机断层扫描（CT）证实了双侧 PE。患者在 CPR 后 3 周出院，神经状况良好。据我们所知，这是首例描述院前溶栓治疗联合 AMCC 在院外心脏骤停中的应用。然而，目前，在 CPR 中使用院前溶栓治疗仍然是一项应根据具体情况基于知情决策来进行的措施。需要进一步的研究来评估溶栓治疗与 AMCC 联合应用和长时间 CPR 的疗效和安全性。
