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Cardiac Arrest Following Massive Pulmonary Embolism During Mechanical Declotting of Thrombosed Hemodialysis Fistula: Successful Resuscitation With tPA

St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY

Shigeki Saito, MD

St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY

Carmen Patrascu, MD

St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY

Raymonde Jean, MD

St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, RJean{at}chpnet.org

Percutaneous declotting of a thrombosed fistula or graft is standard of care and is a safe procedure. Subclinical pulmonary embolism (PE) during this procedure occurs commonly, but symptomatic PE is extremely rare. The authors report a case of declotting-associated massive PE with cardiopulmonary arrest and successful resuscitation. The patient developed a new right-axis deviation and right-bundle branch block. Diagnosis of PE was confirmed with a computed tomography (CT) angiogram, and the patient received tissue plasminogen activator (tPA) and heparin. She required norepinephrine and dobutamine temporarily and was subsequently extubated successfully. Massive PE is a very rare complication of this procedure. Given the grave outcome, the clinical signs and symptoms should be recognized immediately and treatment instituted early.

Key Words: pulmonary embolism • mechanical declotting • tissue plasminogen activator (tPA) • cardiopulmonary arrest

Journal of Intensive Care Medicine, Vol. 23, No. 2, 143-145 (2008)
DOI: 10.1177/0885066607313002


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