Successful Alteplase Bolus Administration for a Presumed Massive Pulmonary Embolism During Cardiopulmonary Resuscitation

Prom, Rathasen; Dull, Ryan; Delk, Bethany

doi:10.1177/1060028013508644

Cited by 7 publications

(3 citation statements)

References 54 publications

(126 reference statements)

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“…Among the treatment methods, fibrinolysis has a practical use since it can be applied quickly and easily and is available in most health institutions. In arrest cases, fibrinolytic therapy combined with chest compressions can increase survival by restoring spontaneous circulation 11 . In studies conducted, mortality rates varying between 22% and 90% have been reported after fibrinolytic therapy 9,12 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Systemic Thrombolytic Treatment in the Emergency Service in Unstable and Resuscitated Patients Due to Massive Pulmonary Embolism

Bilir

ÜNLÜ

Taşçı

et al. 2022

Eurasian Journal of Critical Care

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Background: PE accounts for 3% of out-of-hospital cardiac arrest. In this case, treating patients with thrombolysis during resuscitation has been associated with better survival. Objective: The aim of this study is to evaluate the use of systemic thrombolytic in unstable and/or resuscitated patients who are evaluated in the red area in emergency service practice and who are diagnosed with massive pulmonary embolism with bedside examinations. Methods: This prospective study was designed on 17 patients who were transferred as unstable to the emergency service of a tertiary hospital by Emergency Health Services and/or who needed resuscitation due to non-shockable fatal rhythm disorder on admission and who underwent systemic thrombolysis due to the diagnosis of pulmonary embolism during resuscitation. Results: Of the 17 patients included in the study, 52.9% were discharged and improvement was detected in unstable vital findings in 47.1% patients after thrombolysis. Of the bedside examinations performed on admission, ECG showed T wave negativity at V1-4 deviations and P-pulmonale in 41.2% patients and ECHO showed right ventricle dilatation indicating right ventricle dysfunction in 82.4% patients. CTPA taken after stabilization showed thrombus at bilateral pulmonary artery in 88.2% patients. Conclusion: Cardiopulmonary arrest caused by PE is a life-threatening condition that requires urgent systemic thrombolysis. Patients who are evaluated as unstable or in need of resuscitation in the emergency service should be diagnosed quickly as a result of examinations performed at bed-side and thrombolytic treatment should be started.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Systemic Thrombolytic Treatment in the Emergency Service in Unstable and Resuscitated Patients Due to Massive Pulmonary Embolism

Bilir

ÜNLÜ

Taşçı

et al. 2022

Eurasian Journal of Critical Care

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“…This was the fastest published administration of rt-PA for PE, although these patients were not in cardiac arrest. Various dosing and infusion times have been studied, but there is a lack of clinical head-to-head studies to definitively say which regimen is best (Prom, Dull, & Delk, 2013). When administering rt-PA for cardiac arrest, it requires prolongation of cardiopulmonary resuscitation (CPR).…”

Section: Cardiac Arrestmentioning

confidence: 99%

Alteplase for the Treatment of Pulmonary Embolism

Peters

Paciullo

2015

Advanced Emergency Nursing Journal

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Pulmonary embolism can present with a wide range of symptoms, from asymptomatic to cardiac arrest, making diagnosis challenging. Alteplase is a fibrinolytic that is indicated for the treatment of pulmonary embolism in intermediate- and high-risk patients. Controversy exists as to the patient population that will benefit most from fibrinolytic therapy, as well as the proper dose and administration technique. The patient's risk of bleeding should be weighed against the potential benefits of treatment in light of the clinical presentation because of the high mortality rate associated with pulmonary embolism. Nurses at the bedside must monitor for signs of bleeding when alteplase is administered. Fibrinolytic therapy will frequently be started in the emergency department, and the nurse must ensure that alteplase is administered in a safe and effective manner. This review discusses the clinical evidence for alteplase in pulmonary embolism and its specific role in treatment.

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“…Two 50-mg doses of alteplase were mixed at the bedside by pharmacy staff in accordance with guideline recommendations and case reports of success improving survival with the use of bolus-dose alteplase therapy during cardiopulmonary resuscitation. 12-14 Each dose was given over 2 minutes and circulated by cardiopulmonary resuscitation for 15 minutes, with return of spontaneous circulation (ROSC) achieved after the second dose was administered. Afterward, pharmacy personnel were consulted for a recommendation regarding anticoagulation therapy after suspected failure of anticoagulation with LMWH.…”

Section: Case Reportmentioning

confidence: 99%

Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19

Sagardia

Daniels

2020

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported. Summary This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest–associated massive pulmonary embolism after failure of previous anticoagulation efforts. Conclusion Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.

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Successful Alteplase Bolus Administration for a Presumed Massive Pulmonary Embolism During Cardiopulmonary Resuscitation

Cited by 7 publications

References 54 publications

Evaluation of Systemic Thrombolytic Treatment in the Emergency Service in Unstable and Resuscitated Patients Due to Massive Pulmonary Embolism

Evaluation of Systemic Thrombolytic Treatment in the Emergency Service in Unstable and Resuscitated Patients Due to Massive Pulmonary Embolism

Alteplase for the Treatment of Pulmonary Embolism

Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19

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