Successful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report

Massive pulmonary thromboembolism is a condition with high morbidity and mortality if not treated early. A case of a young man with a history of knee trauma that was admitted to the emergency department with sudden dyspnea and syncope is discussed. During the clinical evaluation the patient experienced 5 episodes of cardiac arrest that required prolonged cardiopulmonary-cerebral resuscitation. The diagnosis of massive pulmonary thromboembolism was confirmed by echocardiography and thoracic CT angiography. Although prolonged cardiopulmonary-cerebral resuscitation is a relative contraindication for systemic thrombolysis, the patient experienced remarkable clinical improvement with no sequelae upon hospital discharge.

ResumenEl tromboembolismo pulmonar masivo es una entidad con alta morbilidad y mortalidad si no se trata tempranamente. Se expone el caso de un hombre joven con antecedente de trauma en rodilla quien ingresa al servicio de urgencias por cuadro súbito de disnea y síncope; durante la evaluación clínica presenta 5 episodios de paro cardiaco con requerimiento de reanimación cardiocerebropulmonar prolongada; se confirma el diagnóstico de tromboembolismo pulmonar masivo mediante ecocardiografía y angiotac de tórax. A pesar que la reanimación cardiocerebropulmonar prolongada se considera una contraindicación relativa para trombolisis sistémica, ésta fue administrada, con notoria mejoría clínica, sin ninguna secuela al alta hospitalaria.