BOLUS INJECTION OF THROMBOLYTIC AGENTS DURING CARDIOPULMONARY-RESUSCITATION FOR MASSIVE PULMONARY-EMBOLISM

Thrombolytic therapy has proved to be efficacious in the treatment of massive and fulminant pulmonary embolism (PE), but thrombolysis has be en considered as contraindicated during cardiopulmonary resuscitation (CPR). This review on the administration of thrombolytic agents in pat ients who have suffered massive PE necessitating CPR summarises 14 ane cdotal reports and three case series involving 34 patients. The case s eries revealed an overall initial survival rate of 55-100% following b olus administration of thrombolytic agents. In general, bleeding compl ications were managed conservatively. The establishment of the diagnos is may be feasible using echocardiography or bedside angiography durin g CPR. However, therapeutic measures should be taken without delay; th e patient's history and the clinical picture may thus be the only diag nostic criteria. Even where myocardial infarction is misinterpreted as PE during CPR, bolus injection of a thrombolytic agent can be an appr opriate therapeutic option. An alternative may be mechanical catheter fragmentation of the thrombus with subsequent local thrombolysis. Surg ery may be restricted to hospitals with ready access to extracorporeal circulation. We conclude that early administration of thrombolytic ag ents during PE necessitating CPR may help to reduce mortality. We favo ur the administration of urokinase (2- to 3 000 000-U bolus) or rt-PA.