# Cerebrovascular events and thrombolysis in pulmonary embolism-induced cardiac arrest: a case series and key challenges

## TL;DR

This paper discusses three cases of patients with pulmonary embolism-induced cardiac arrest and the challenges of using thrombolysis while avoiding cerebrovascular events.

## Contribution

The study presents three distinct clinical approaches to managing thrombolysis in PE-induced cardiac arrest.

## Key findings

- Prompt thrombolysis during CPR can lead to a favorable neurological outcome.
- Delayed thrombolysis may result in death despite treatment.
- Contraindications like subarachnoid hemorrhage can lead to poor outcomes.

## Abstract

Cerebrovascular events during thrombolysis in cardiac arrest (CA) caused by pulmonary embolism (PE) is a life-threatening condition. However, the balance between cerebrovascular events and thrombolytic therapy in PE-induced CA remains a great challenge.

In this study, we reported three unique cases regarding main concerns surrounding cerebrovascular events in thrombolytic therapy in PE-induced CA.

The patient in the case 1 treated with thrombolysis during CPR and finally discharged neurologically intact. The patient in the case 2 received delayed thrombolysis and died eventually. The patient in the case 3 was contraindicated to thrombolysis due to the complication of subarachioid hemorrahage and died within days.

Our case series highlights three proposed approaches to consider before administering thrombolysis as a treatment option in PE-induced CA patients: (1) prolonging the resuscitation, (2) administering thrombolysis promptly, and (3) ruling out cerebrovascular events.