Limits...
Successful thrombolytic therapy with recombinant tissue-type plasminogen activator for massive pulmonary embolism -A case report-.

Kim MS, Kim KM, Woo SH, Lim YH, Yon JH, Jeon SG - Korean J Anesthesiol (2010)

Bottom Line: After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator.The patient was transferred to the intensive care unit after his hemodynamic status improved.The patient went on to make a full cardiopulmonary recovery without any complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Massive pulmonary embolism is associated with significant perioperative morbidity and mortality. We report here on a case of a 69-year-old man who suffered a massive pulmonary embolism with pulseless electrical activity during knee arthroscopic surgery. After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator. The patient was transferred to the intensive care unit after his hemodynamic status improved. The patient went on to make a full cardiopulmonary recovery without any complications.

No MeSH data available.


Related in: MedlinePlus

(A) The remaining multiple, mobile thrombi (arrows) in the right atrium (RA) after thrombolysis, as seen on the apical four chamber view. (B) Improvement of the D-shaped left ventricle (LV) after thrombolysis, as seen on the parasternal short axis view. RV: right ventricle, LA: left atrium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2908230&req=5

Figure 2: (A) The remaining multiple, mobile thrombi (arrows) in the right atrium (RA) after thrombolysis, as seen on the apical four chamber view. (B) Improvement of the D-shaped left ventricle (LV) after thrombolysis, as seen on the parasternal short axis view. RV: right ventricle, LA: left atrium.

Mentions: Eight minutes after starting CPR, external cardiac massage was stopped because the vital signs were restored. Arterial blood gas analysis showed pH 6.96, PaCO2 63.9 mmHg, PaO2 221.4 mmHg, HCO3- 13,9 mEq/L and SaO2 98.5% (FiO2: 1.0). Thereafter, with the vital signs fluctuating severely, the CPR was intermittently continued with the administration of epinephrine and sodium bicarbonate on the basis of the hemodynamic status and the results of the arterial blood gas analysis. Ten minutes after initiation of CPR, an emergency transthoracic echocardiogram was performed with the impression of pulmonary embolism and it showed a massive amount of thrombus in the right atrium and a dilated hypokinetic right ventricle with a D shaped left ventricle (Fig. 1). Under the preliminary diagnosis of massive pulmonary embolism, the decision was made to proceed with fibrinolysis while the CPR was ongoing. Thirty-seven minutes after the initiation of CPR, 20 mg of alteplase, which is a r-tPA (Actylase®, Boehringer Ingelheim, Ingelheim, Germany), was administered intravenously and 100 mg was continuously infused over 90 minutes. The echocardiogram after injection of r-tPA showed improvement of the D shaped left ventricle, but multiple, mobile thrombi in the right atrium were still present (Fig. 2). The hemodynamic performance of the systemic and pulmonary circulation was stabilized. There was no sign of bleeding at the operation site. The external cardiac massage was stopped 26 minutes after injecting the recombinant tissue-type plasminogen activator. The patient, who was in an intubated state, was transferred to the intensive care unit. As the patient was transferred to the intensive care unit, the blood pressure increased to 110/60 mmHg and the heart rate was 100 beats per minute, with mechanical ventilation. Heparin was given 12 hours after injecting the r-tPA. The PT was INR was 1.65 and the aPTT was 50-70 seconds. Eighteen hours later, the patient's consciousness became alert and the endotracheal tube was extubated.


Successful thrombolytic therapy with recombinant tissue-type plasminogen activator for massive pulmonary embolism -A case report-.

Kim MS, Kim KM, Woo SH, Lim YH, Yon JH, Jeon SG - Korean J Anesthesiol (2010)

(A) The remaining multiple, mobile thrombi (arrows) in the right atrium (RA) after thrombolysis, as seen on the apical four chamber view. (B) Improvement of the D-shaped left ventricle (LV) after thrombolysis, as seen on the parasternal short axis view. RV: right ventricle, LA: left atrium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908230&req=5

Figure 2: (A) The remaining multiple, mobile thrombi (arrows) in the right atrium (RA) after thrombolysis, as seen on the apical four chamber view. (B) Improvement of the D-shaped left ventricle (LV) after thrombolysis, as seen on the parasternal short axis view. RV: right ventricle, LA: left atrium.
Mentions: Eight minutes after starting CPR, external cardiac massage was stopped because the vital signs were restored. Arterial blood gas analysis showed pH 6.96, PaCO2 63.9 mmHg, PaO2 221.4 mmHg, HCO3- 13,9 mEq/L and SaO2 98.5% (FiO2: 1.0). Thereafter, with the vital signs fluctuating severely, the CPR was intermittently continued with the administration of epinephrine and sodium bicarbonate on the basis of the hemodynamic status and the results of the arterial blood gas analysis. Ten minutes after initiation of CPR, an emergency transthoracic echocardiogram was performed with the impression of pulmonary embolism and it showed a massive amount of thrombus in the right atrium and a dilated hypokinetic right ventricle with a D shaped left ventricle (Fig. 1). Under the preliminary diagnosis of massive pulmonary embolism, the decision was made to proceed with fibrinolysis while the CPR was ongoing. Thirty-seven minutes after the initiation of CPR, 20 mg of alteplase, which is a r-tPA (Actylase®, Boehringer Ingelheim, Ingelheim, Germany), was administered intravenously and 100 mg was continuously infused over 90 minutes. The echocardiogram after injection of r-tPA showed improvement of the D shaped left ventricle, but multiple, mobile thrombi in the right atrium were still present (Fig. 2). The hemodynamic performance of the systemic and pulmonary circulation was stabilized. There was no sign of bleeding at the operation site. The external cardiac massage was stopped 26 minutes after injecting the recombinant tissue-type plasminogen activator. The patient, who was in an intubated state, was transferred to the intensive care unit. As the patient was transferred to the intensive care unit, the blood pressure increased to 110/60 mmHg and the heart rate was 100 beats per minute, with mechanical ventilation. Heparin was given 12 hours after injecting the r-tPA. The PT was INR was 1.65 and the aPTT was 50-70 seconds. Eighteen hours later, the patient's consciousness became alert and the endotracheal tube was extubated.

Bottom Line: After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator.The patient was transferred to the intensive care unit after his hemodynamic status improved.The patient went on to make a full cardiopulmonary recovery without any complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Massive pulmonary embolism is associated with significant perioperative morbidity and mortality. We report here on a case of a 69-year-old man who suffered a massive pulmonary embolism with pulseless electrical activity during knee arthroscopic surgery. After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator. The patient was transferred to the intensive care unit after his hemodynamic status improved. The patient went on to make a full cardiopulmonary recovery without any complications.

No MeSH data available.


Related in: MedlinePlus