Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy)

Abstract

Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR) which was followed by therapeutic hypothermia (TH). The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT) of the chest confirmed massive pulmonary embolism (PE), the patient was administered thrombolytic therapy with Metalyse (tenecteplase) and anti­coagulation therapy (heparin). After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

Keywords

• pulmonary embolism
• acute cardiac arrest
• cardiopulmonary resuscitation
• post­resuscitation period
• hypothermia
• neurological outcome