Thrombolytic therapy of massive pulmonary embolism during prolonged cardiac arrest using recombinant tissue-type plasminogen activator.

Cardiac arrest caused by massive pulmonary embolism is highly refractory to conventional resuscitation. Emergency surgical embolectomy has been considered the only effective intervention. We present the case of a 33-year-old woman who suffered a massive pulmonary embolism with circulatory arrest refractory to one half hour of aggressive CPR. A 10-mg bolus of recombinant tissue-type plasminogen activator was administered through a central line followed by a further 90-mg IV infusion over two hours. Rapid hemodynamic and clinical improvement followed the bolus dose. The patient was discharged later without neurological or other sequelae. This is the first reported case of successful thrombolytic therapy of massive pulmonary embolism during prolonged CPR.