Thrombolysis in resuscitated patients with pulmonary embolism

A retrospective analysis is presented of data from 17 patients with proven pulmonary embolism (10 women, 7 men, mean age 50.8 [18-76] years) who had received short-term high dosage thrombolytic therapy shortly before or after (less than 24 h) undergoing mechanical resuscitation. The mean duration of resuscitation was 76 (20-160) minutes. Two patients had already been resuscitated half an hour and one hour, respectively, before the commencement of thrombolysis. In nine other patients thrombolysis was commenced during resuscitation. Hospital mortality in the latter group was amazingly low (four of nine patients died). In contrast, out of six patients who required resuscitation shortly after the commencement of thrombolysis, not one survived. Haemorrhagic complications occurred in four out of the 17 patients, but only in two were they directly attributable to the resuscitation: one female patient developed an extensive haematoma in the sternal region, and two days after resuscitation another female patient had a haemorrhage into the capsule of the liver during thrombolytic therapy which had been continued because of leg vein thrombosis. In the light of these results it seems justifiable, even on mere clinical suspicion of pulmonary embolism, to initiate short-term high dosage thrombolytic therapy during or after resuscitation.