Thrombolysis in a Case of Cardiac Arrest due to Massive Pulmonary Embolism with Ongoing CardioPulmonary Resuscitation: a Case Report

Pulmonary embolism (PE) is a life-threatening condition which often gets missed due to non-specific initial presentation in the Emergency Department (ED). We report a case of a young male who presented to the ED with sudden onset breathlessness and diaphoresis. Appropriate resuscitation was initiated. Soon after patient started gasping and had a cardiac arrest with first monitored rhythm being pulseless electrical activity (PEA). Cardio-pulmonary resuscitation (CPR) was initiated and continued as per ACLS protocol. Portable Echocardiograph revealed severe pulmonary hypertension with right ventricular dysfunction. Provisional diagnosis of PE was made and patient was managed with immediate thrombolysis with ongoing CPR. Brief episodes of cardiac arrest occurred which were successfully revived following which he remained hemodynamically stable. Diagnosis was confirmed by Colour Doppler of bilateral lower limbs and pulmonary angiogram. Patient was weaned off ventilator within 24 hours and discharged home after a week with full neurological recovery. Timely diagnosis and management were key in this patient’s survival.