Gupta Raghav, Jindal Aditi, Cranston-D'Amato Hope
Department of Internal Medicine, Critical Care Medicine and Infectious Disease, St. Luke's Hospital, Chesterfield, Missouri, USA.
Department of Pediatric Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.
Int J Crit Illn Inj Sci. 2014 Jan;4(1):88-90. doi: 10.4103/2229-5151.128021.
A 52-year-old non-smoking Caucasian male, who was admitted to our emergency room after he was found unconscious in the bathroom, went into cardiac arrest requiring prolonged cardiopulmonary resuscitation (CPR) and hypothermia therapy. Cardiac catheterization showed non-obstructive coronary arteries and further bedside echocardiogram suggested probable pulmonary embolism (PE) as an underlying cause of cardiac arrest. Although thrombolytic therapy is an effective therapy for PE, it is not routinely given during prolonged CPR for its life- threatening bleeding complications. Many reported cases have suggested a beneficial effect of empiric thrombolytic in cardiac arrest, but unrelated to duration of resuscitation and adjuvant treatments that imposes bleeding risk. We suspect that tissue plasminogen activator (tPA) should be promptly given to prolonged cardiac arrest patients, even when bleeding risk is high with the concurrent hypothermia treatment, keeping the benefits over risk strategy. Our patient received thrombolytic, tPA and showed remarkable clinical, physiological and radiographical improvement.
一名52岁的非吸烟白种男性，在浴室中被发现昏迷后被送入我们的急诊室，随后发生心脏骤停，需要长时间的心肺复苏（CPR）和低温治疗。心脏导管检查显示冠状动脉无阻塞，进一步的床边超声心动图提示可能的肺栓塞（PE）是心脏骤停的潜在原因。尽管溶栓治疗是治疗PE的有效方法，但在长时间CPR期间，由于其危及生命的出血并发症，通常不会常规使用。许多报道的病例表明，经验性溶栓对心脏骤停有有益作用，但与复苏持续时间和增加出血风险的辅助治疗无关。我们怀疑，即使在同时进行低温治疗出血风险很高的情况下，也应及时给予组织纤溶酶原激活剂（tPA）治疗长时间心脏骤停的患者，遵循获益大于风险的策略。我们的患者接受了溶栓药物tPA治疗，临床、生理和影像学方面均有显著改善。
