Thrombolytic agents are a potential rescue therapy to restore perfusion after cardiac arrest from acute pulmonary embolism. Consider these points when deciding whether to administer thrombolytics:
- Immediately establishing a confirmed diagnosis is difficult, prompting physicians to rely on risk stratification and clinical suspicion. Point-of-care ultrasound may be considered to guide the decision to administer rescue thrombolytics. High-risk features suggestive of PE include RV dilation and interventricular septal bulging. (Proc [Bayl Univ Med Cent]. 2021;34:442; https://bit.ly/3CH0NPF.)
- It is unclear if early thrombolysis correlates with better outcomes, but it is recommended when there is a high clinical suspicion that PE is the cause of the arrest. Thrombolytics had been administered within 15 minutes for the three survivors in one study that described outcomes in 22 patients who received rescue thrombolysis. (Ann Pharmacother. 2019;53:711; https://bit.ly/3ixlc2T.)
- The most common thrombolytic regimen used is alteplase 50 mg IV push, repeating in 10 to 30 minutes if ROSC is not achieved.
- The effect of the drug is not immediate, and CPR may be needed for some time after thrombolysis depending on the clinical context. The European Resuscitation Council Guidelines recommend continuing CPR for at least 60 to 90 minutes after thrombolysis before terminating resuscitation. (Eur Respir J. 2019;56:543; https://bit.ly/3IO83Ns.)
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