[First results of emergency treatment in massive fulminant lung embolism by means of a rapidly injected streptokinase in a high initial dose (author's transl)].

Five cases of patients with massive fulminant lung embolism are reported who were successfully reanimated in spite of one or several cardiac arrests by bolus injection of 750,000 to 1,000,000 I.U. streptokinase applicated intraveneously within a few seconds up to about 3 min. The effect of this rapidly injected high initial dose of streptokinase on the embolus in the A. pulmonalis and on the disturbed microcirculation in prefinale states of shock is discussed. In consequence of the aggressive therapy with streptokinase severe haemorrhagic complications occurred in all cases reported. As the patients would not have survived the massive fulminant lung embolism without this therapy it is concluded that in certain cases of fulminant lung embolism the bolus injection of streptokinase should be tried besides other measures of reanimation as a ultima ratio in spite of a contraindicated lysis. We think that this aggresive therapy is indicated for patients with massive fulminant lung embolism who were treated in a conventional way without success, who could not be operated or who had already suffered from a cardiac arrest. It is suggested to treat a massive fulminant lung embolism not only with conventional measures of reanimation but also with rapid i.v.-injection of 750,000 to 1,000,000 I.U. of streptokinase.