Diagnosis of acute pulmonary embolism by point-of-care ultrasound under continuous cardiopulmonary resuscitation: case series

TL;DR

This case series shows how point-of-care ultrasound can help diagnose and treat life-threatening blood clots in the lungs during emergency resuscitation.

Contribution

Demonstrates the use of point-of-care ultrasound for diagnosing pulmonary embolism during CPR and guiding thrombolytic therapy.

Findings

Three patients with cardiac arrest due to pulmonary embolism were diagnosed using point-of-care ultrasound during CPR.

Systemic thrombolytic therapy with Alteplase during CPR led to return of spontaneous circulation in these cases.

Abstract

Acute pulmonary embolism, as one of the most common and dangerous diseases, sometimes can develop into cardiac arrest before receiving Computed Tomography Angiography (CTA) or other confirmatory workup. The success rate with merely Cardiopulmonary resuscitation (CPR) is extremely low, which raises the question whether it is appropriate to make medical decisions and treat patients empirically with systemic thrombolytic therapy based on point-of-care ultrasound.

This case series reported three cases in which patients presented with cardiac arrest in the emergency department, given the cases were too emergent for CTA, pulmonary embolism was diagnosed based on point-of-care ultrasound given the emergency of the condition, the patient was given systemic thrombolytic therapy with continuous CPR, and achieved Return of Spontaneous Circulation (ROSC).

These cases discuss the importance of bedside ultrasound in the rapid identification of acute pulmonary embolism and the importance of intravenous thrombolysis in the context of continuous cardiopulmonary resuscitation.

Point of care ultrasound plays a crucial role in rapidly identifying acute pulmonary embolism in the emergency department. Systematic therapy with continuous CPR is an effective management for patients with cardiac arrest secondary to acute pulmonary embolism.

•This case series presents three patients who experienced cardiac arrest secondary to pulmonary embolism.•Point-of-care ultrasound (POCUS) is the most direct and effective way to detect acute pulmonary embolism during ongoing cardiopulmonary resuscitation (CPR).•Empiric intravenous thrombolytic therapy with Alteplase (rtPA) during continuous cardiopulmonary resuscitation is essential for achieving return of spontaneous circulation (ROSC) in case of suspected pulmonary embolism.

This case series presents three patients who experienced cardiac arrest secondary to pulmonary embolism.

Point-of-care ultrasound (POCUS) is the most direct and effective way to detect acute pulmonary embolism during ongoing cardiopulmonary resuscitation (CPR).

Empiric intravenous thrombolytic therapy with Alteplase (rtPA) during continuous cardiopulmonary resuscitation is essential for achieving return of spontaneous circulation (ROSC) in case of suspected pulmonary embolism.

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