Successful treatment of presumed massive pulmonary embolism during cardiac arrest

Mieka D. Close, David Cherkas

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5 Scopus citations


A 53-year-old man with a history of prior pulmonary embolism and recent foot surgery with lower extremity cast presented to the emergency department with dyspnea and mild tachycardia. Before spiral computed tomography of the pulmonary vessels could be obtained, cardiac arrest occurred. Based on a high clinical suspicion of massive pulmonary embolism, fibrinolytic therapy was administered in the form of 10 units of intravenous reteplase, in conjunction with standard cardiopulmonary resuscitation and advanced cardiac life support protocols. Within 2 minutes of administration of reteplase, return of spontaneous circulation occurred, and the patient became awake and alert. The diagnosis of massive pulmonary embolism was confirmed by computed tomography, and a second bolus dose of reteplase was administered. The patient underwent no major bleeding complications and was admitted to the intensive care unit. This is the first documented case of successful use of reteplase for presumed massive pulmonary embolism during cardiac arrest in the United States.

Original languageEnglish
Pages (from-to)132.e3-132.e4
JournalAmerican Journal of Emergency Medicine
Issue number1
StatePublished - Jan 2011


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