Pulmonary Vascular Disease |

Prolonged Chest Compressions During Cardiopulmonary Resuscitation for Cardiac Arrest Due to Acute Pulmonary Embolism FREE TO VIEW

Carla Nobre, MD; Dinis Mesquita, MD; Boban Thomas, MD
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CHBM, Barreiro, Portugal

Chest. 2014;145(3_MeetingAbstracts):532A. doi:10.1378/chest.1824624
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Thrombolytic therapy is used for acute pulmonary embolism complicated by shock or cardiopulmonary arrest. Its efficacy is limited by the lack of systemic perfusion required for lysis of the thrombus in the pulmonary vasculature. The only efficacious form of circulatory support may be temporary extracorporeal membrane oxygenator (ECMO) use with venous-arterial cannula. In the absence of ECMO support, prolonged chest compressions after thrombolysis may be required to support the circulation.

METHODS: Six patients had an episode of cardiopulmonary arrest preceded by systemic hypotension in three. Standard CPR was initiated in all patients, followed by echocardiography and by thrombolytic therapy using Tenecteplase in a weight-based regime, if echo revealed findings suggestive of acute PE. After thrombolytic therapy, chest compressions were continued for 40, 48, 55, 61, 70 and 80 minutes in the six patients.

RESULTS: Four patients survived to discharge, and one had anoxic encephalopathy. No patient had any cardiac contractions detected by echo until at least 30 minutes of compressions were performed.

CONCLUSIONS: Prolonged chest compressions may be required to facilitate thrombolysis in acute PE, if ECMO is not available for circulatory support. Return of cardiac systolic contractions can be confirmed by echo and CPR may have to be continued even if there is some cardiac activity to maintain circulatory support. Images on echocardiography will be presented.

CLINICAL IMPLICATIONS: Prolonged chest compressions may be required during thrombolytic therapy for acute PE and cardiopulmonary arrest. Guided by bedside echo or ultrasound, it is important to persist with compressions for at least 40 minutes for recovery of cardiac contractions sufficient to maintain systemic perfusion.

DISCLOSURE: The following authors have nothing to disclose: Carla Nobre, Dinis Mesquita, Boban Thomas

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