Thrombolytic treatment (alteplase; rt-PA) in acute massive pulmonary embolism and cardiopulmonary arrest

Adem Dirican,1 Sevket Ozkaya,2 Ali Ekber Atas,3 Esra Kayahan Ulu,4 Ilknur Kitapci,5 Ferah Ece21Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahçesehir University, Istanbul, Turkey; 3Department of Cardiology, Medical Park Samsun Hospital, Samsun, Turkey; 4Department of Radiology, Medical Park Samsun Hospital, Samsun, Turkey; 5Department of Intensive Care Unit, Medical Park Samsun Hospital, Samsun, TurkeyAbstract: Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.Keywords: massive pulmonary embolism, thrombolytic treatment, rt-PA, cardiopulmonary arrest, resuscitation, mortality, hemorrhage