# Low-dose tenecteplase during cardiopulmonary resuscitation in massive pulmonary embolism

## TL;DR

A young man with sudden breathing trouble and cardiac arrest was successfully treated with low-dose tenecteplase for a massive blood clot in the lungs.

## Contribution

This case demonstrates the effectiveness of low-dose tenecteplase during CPR for massive pulmonary embolism without clear risk factors.

## Key findings

- Low-dose tenecteplase during CPR restored spontaneous circulation in a patient with suspected massive pulmonary embolism.
- Echocardiography during CPR identified right heart strain indicative of pulmonary embolism.
- CT Pulmonary Angiography confirmed the presence of massive pulmonary embolism after successful resuscitation.

## Abstract

We report the case of an 18-year-old male who presented to the Emergency Department with sudden onset dyspnea. The patient was intubated on arrival, but suffered a cardiac arrest soon after. Point-of-care echocardiography during cardiopulmonary resuscitation revealed a grossly dilated right atrium and right ventricle, which alerted the Emergency physician to the possibility of massive pulmonary embolism leading to cardiac arrest. Due to no discernible history or risk factors in favour of pulmonary embolism, a decision was taken for thrombolysis with half dose Tenecteplase. Return of spontaneous circulation was achieved 14 min after thrombolysis, with massive pulmonary embolism subsequently being confirmed on CT Pulmonary Angiography.