Aggressive Therapeutic Approach in a Patient with Extremely Prolonged Prehospital Cardiac Arrest due to Massive Pulmonary Thromboembolism

Abstract

Background: Pulmonary thromboembolism is the most severe clinical manifestation of venous thromboembolism, with approximately one-third of patients dying from cardiovascular collapse within the first hours of presentation, often before the diagnosis is confirmed and therapy initiated. Anoxic brain injury with persistent comatose state remains a major complication following prolonged cardio-pulmonary resuscitation.Clinical case: We present a 58-year-old female patient with pulmonary thromboembolism who experienced cardiac arrest during a pre-hospital clinical examination, during which a mobile thrombus in the right atrium was visualized by echocardiography. Simultaneously with cardiopulmonary resuscitation, systemic fibrinolysis was performed, which was carried out without complications, and spontaneous circulation was restored 45 minutes after the onset of cardiac arrest. The subsequent comatose state resulting from cerebral hypoperfusion/reperfusion was treated with targeted control of central body temperature in the context of intensive therapy for cardiogenic shock. The patient regained consciousness and cognitive function and was discharged without neurological deficits and with stable hemodynamics.Conclusion: We confirm the effectiveness of thrombolytic therapy in high-risk thromboembolism and prolonged resuscitation efforts exceeding 30 minutes, combined with a strategy for temperature control, when the patient presents with cardiac arrest and the possibility of a favorable clinical outcome.