Thrombolysis during continuous chest compression in a patient with cardiac arrest due to pulmonary embolism: prolonged cardiopulmonary resuscitation-induced spinal cord injury.

Pulmonary embolism (PE) is a life-threatening condition, and cardiac arrest is the most serious clinical circumstance. Clinical practice guidelines recommend systemic thrombolysis for high-risk or massive PE patients as the primary treatment. However, there are insufficient data to argue for or against the routine use of thrombolytic therapy during cardiac arrest. We report a 47-year-old man with acute PE complicated by cardiac arrest with pulseless electrical activity. Intravenous thrombolytic therapy with 1.5 million U of urokinase was performed by a constant infusion pump within 30 minutes during continuous mechanical chest compression with LUCAS (Jolife AB, Lund, Sweden). After 46 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved, and the patient eventually survived to discharge. Unfortunately, he had an irreversible spinal cord injury due to prolonged cardiopulmonary resuscitation and traumatic injury.