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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Thrombolytic therapy of massive pulmonary embolism during prolonged cardiac arrest using recombinant tissue-type plasminogen activator. 249 30

Between January 1979 and December 1982, 84 patients between the ages of 1 and 39 years presented to the emergency department in a state of cardiac arrest. There were 58 male patients (69%) and 26 female patients (31%) in the group. Presenting rhythms were ventricular fibrillation (37%), asystole (37%), idioventricular rhythm (14%), heart block (4%), bradycardia (4%), ventricular tachycardia (3%), and electromechanical dissociation (3%). Thirty-two percent had bystander CPR. Of 21 patients initially resuscitated (25%), only four (5%) survived to discharge from the hospital. All survivors were neurologically intact. Seventy-five of the 80 patients who died (90%) underwent autopsy. Cause of death in the five remaining patients was inferred from clinical history. Etiologies of the cardiac arrests were the following: toxic exposure or ingestion (26%), atherosclerotic heart disease (23%), undetermined (11%), pulmonary embolism (6%), hemorrhage (6%), epilepsy (2%), cardiomyopathy (7%), myocarditis (2%), pneumonia (4%), and one case each of airway obstruction, asthma, peptic disease, and septic shock. Diverse etiologies should lead to a diagnostic search for reversible conditions in young patients. The prognosis for hospital discharge is poorer in the young population than is reported in our overall cardiac arrest population; however, numbers of neurologically intact survivors are similar in the young and the overall cardiac arrest population.
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PMID:Cardiac arrest under age 40: etiology and prognosis. 648 35

In patients with deep venous thrombosis, there is a recent trend towards surgical thrombectomy to avoid late complications. However, up to 10% of these patients suffer from severe intraoperative pulmonary embolism, 30 to 40% of whom die on the operating table. Treatment options for massive pulmonary embolism include embolectomy (high mortality), transvenous thrombus fragmentation techniques, and thrombolytic therapy. However, while thrombolysis is recommended as the treatment of choice for PTE, it is usually considered contraindicated in surgical patients because of bleeding complications. We report on 5 cases of severe pulmonary thromboembolism with marked cardiogenic shock during venous thrombectomy. Three patients were treated successfully by intraoperative thrombolysis alone or in combination with mechanical fragmentation of the embolus using a catheter technique under fluoroscopy (one case). Diagnosis was established by a sudden decrease of mean arterial pressure (from 83 to 45 mmHg), a marked increase of mean pulmonary artery pressure (MPAP) (from 16 to 43 mmHg), hypoxaemia (SaO2 < 90%), an increased arterial-to-end-tidal CO2-difference (from 7 to 42 mmHg), and/or pulmonary angiography (2 cases). All patients had to be treated with high dosages of catecholamines (norepinephrine 0.5 microgram.kg-1.min-1 or epinephrine 0.1 microgram.kg-1.min-1, and dopamine 6-15 micrograms.kg-1.min-1). Three patients required CPR prior to or during thrombolytic therapy. Thrombolysis was started intraoperatively with rt-PA with dosages ranging from 20 to 90 mg, applied in single injections (5-75 mg) followed by infusions (5 or 10 mg.h-1) for up to 8 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intraoperative thrombolysis with rt-PA in massive pulmonary embolism during venous thrombectomy]. 781 77

Circulatory effects of cardiopulmonary resuscitation with active compression-decompression (CPR-ACD) are superior to the conventional technique. Decompression, thoracic expansion and a corresponding suction effect obviously improves cardiac preload. Due to significant or unphysiological thoracic expansion, thorax, diaphragma, and epigastrium are exposed to considerable traction powers. In a patient with fulminant pulmonary embolism, conventional cardiac massage and ACD were maintained during 65 minutes with simultaneous systemic thrombolytic therapy. After CPR, the patient developed a massive haemorrhagic shock. During emergency laparotomy, significant adhesions of upper abdominal organs with serious injuries of spleen and liver were found. Traction powers during CPR-ACD in combination with abdominal adhesions are considered responsible. Until improved outcome of CPR-ACD is demonstrated in larger clinical investigations, at least initially conventional cardiac massage should be preferred before the ACD-technique is used. Special attention to patients with a history of upper abdominal operations or chronic inflammatory lung diseases is mandatory.
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PMID:[Specific risks of active compression-decompression in cardiopulmonary resuscitation: a case report]. 912 58

End-tidal carbon dioxide (PetCO2) monitoring is becoming more common in both the ED and the out-of-hospital setting. Its main use has been as an aid when confirming endotracheal intubation. Other uses in the ED include monitoring CPR efforts and monitoring the ventilatory and hemodynamic status of intubated and nonintubated patients. In addition, future uses may include using PetCO2 as an adjunct when monitoring the status of asthma treatment, when making the diagnosis of pulmonary embolism, and when measuring cardiac output noninvasively. This article reviews these specific uses of PetCO2 monitoring in emergency medicine.
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PMID:End-tidal carbon dioxide monitoring in emergency medicine, Part 2: Clinical applications. 992 85

Central pulmonary embolism represents one of the most threatening complications in surgical patients. In most cases deep vein thrombosis of the lower extremities is the source of emboli. Despite the introduction of hypocoagulative drugs in standard surgical concepts the incidence of deep vein thrombosis remains about 10% in trauma patients. Estimated numbers of unknown cases of pulmonary embolism are supposed to be rather high too. In haemodynamically symptomatic pulmonary embolism events and especially when the patient has to be reanimated, mortality rates of up to 93% are reported in literature. After introduction of the heart- and lung-machine in the surgical concept of therapy, survival rates have increased significantly. We report on three cases of successful surgical embolectomy after CPR. In a review of literature current concepts of treatment in central pulmonary embolism are discussed.
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PMID:[Surgical embolectomy after reanimation in central pulmonary embolism]. 1035 44

Recently, efforts have been undertaken to investigate the effects of thrombolysis during cardiopulmonary resuscitation (CRP) in patients suffering from massive pulmonary embolism or acute myocardial infarction. In up to 70% of patients with cardiac arrest, one of these two diseases is the underlying cause of deterioration. Nevertheless, thrombolysis has not been conducted during CPR because of the fear of severe bleeding complications. However, an increasing number of clinical studies suggest that thrombolytic therapy during CPR can contribute to haemodynamic stabilisation and survival in patients with massive pulmonary embolism and acute myocardial infarction, when conventional CPR procedures have been performed unsuccessfully. Apart from the specific causal action of thrombolytic agents at the site of pulmonary emboli and coronary thrombosis, experimental data indicate that thrombolysis during CPR can improve microcirculatory reperfusion, which may be most important in the brain. In accordance with these data, marked activation of blood coagulation without adequate activation of endogenous fibrinolysis has been demonstrated early after cardiac arrest. In summary, thrombolysis during CPR is presently a treatment strategy that can be performed on an individual basis in patients with pulmonary embolism or acute myocardial infarction. It may become a routine measure if positive results of randomised, controlled clinical trials will be available in the future.
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PMID:Thrombolytic therapy during cardiopulmonary resuscitation. 1202 80

The main goal of the cardiopulmonary resuscitation is good neurological outcome. The primary ischaemic insult initiates a multitude of coagulation and inflammatory cascades resulting in cytotoxic brain oedema, necrosis and apoptosis. Thrombolytic agents may have experimentally and clinically significant beneficial effects in non-traumatic cardiac arrest. Prospective clinical trials show that thrombolytic therapy combined with heparin is feasible, safe and effective during resuscitation. We demonstrate three cases of successful systemic thrombolysis during in hospital CPR in cancer patients. Two patients were successfully resuscitated from cardiac arrest with streptase bolus (500.000 IU) and infusion (100,000/hr). One patient with pulmonary embolism and gynecological bleeding were treated with bolus (10,000 IU) and infusion of heparin (1,000 IU/hr) and successfully resuscitated. We observed a very good neurological outcome in all 3 cases following rescue thrombolysis and standard CPR. Two patients were discharged from hospital in good neurological outcome. One patient died on ICU on 10th day due to myocardial re-infarction and biventricular failure. Systemic thrombolysis is safe and effective treatment modality during resuscitative efforts even in cancer patients. In oncological patients with dissemination and/or bleeding heparin therapy should be considered due to better clinical control. (Ref. 17.)
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PMID:Rescue systemic thrombolysis during cardiopulmonary resuscitation. 1251

Due to the growing number of high-risk patients, the increasing proportion of geriatric patients and the expansion of surgical and invasive-diagnostic procedures, medical stuff in hospitals are confronted with a rising number of emergency situations. Nearly 50% are of cardio-circulatory origin and occur during surgical interventions or immediately afterwards. Another cause of life-threatening complications are side-effects of orally or intravenously administered agents, especially after treatment with antibiotics, anaesthetics, analgetics and sedatives. Due to a lack of emergency training and management in most hospitals, the survival rate after cardiopulmonary resuscitation in general wards lies between just two and 35%. Thus it seems necessary to perform special training in CPR procedures and emergency management at regular intervals for the entire medical stuff. In addition, a special infrastructure for giving sufficient treatment in emergencies has to be established (emergency team, emergency telephone number, intra-hospital emergency car). The second part of this review presents current diagnostic and therapeutic strategies for the most common emergency situations, e.g. anaphylaxis, myocardial infarction, pulmonary embolism, gastrointestinal bleeding, and heparin-induced thrombocytopenia (HIT).
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PMID:[Treatment of emergencies in the hospital--problems and management]. 1275 63

Cardiac arrest carries a very poor prognosis. More than 70% of cardiac arrests are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis during CPR has two major effects: first, it causally treats the condition that caused cardiac arrest and second, it has been shown to have beneficial effects on the microcirculatory cerebral reperfusion after cardiac arrest. However, this treatment has been widely withheld mainly because of the fear of severe bleeding complications. We reviewed the currently available in- and out-of-hospital studies on thrombolysis during CPR. Most studies found that thrombolytic therapy during CPR improves the chance for a restoration of spontaneous circulation in patients suffering from cardiac arrest and may even result in a better outcome. In addition, the neurological condition of surviving patients may be markedly improved by thrombolysis. Although thrombolytic therapy is associated with a risk of bleeding complications, currently available data do not suggest an increase of bleeding complications if thrombolysis is administered during CPR. Recently, a large randomized multicentre study has started to assess the efficacy and safety of thrombolysis during prehospital CPR.
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PMID:Thrombolytics in CPR. Current advantages in cardiopulmonary resuscitation. 1588 90


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