Ultra-long cardiopulmonary resuscitation with thrombolytic therapy for a sudden cardiac arrest patient with pulmonary embolism

The recovery of cardiac arrest patients with pulmonary embolism who are given an ultra-long duration of cardiopulmonary resuscitation(CPR) with manual chest compressions is very rare. We reported a 52-year-old woman who came to the hospital because of paroxysmal dyspnea. She experienced in hospital cardiac arrest and underwent prolonged CPR with manual chest compressions for 160 minutes. The patient presented with several episodes of cardiac electrical activity that lasted 10 to 20 seconds without consciousness. Blood gas analysis revealed pH 7.27, PaO2 51 mm Hg, and D-dimer 3723 ìg/mL. In addition,acute pulmonary embolism was considered due to the patient's symptoms. Thrombolytic therapy was given 100 minutes after the CPR was implemented. Sixty minutes later, her sinus rhythm was restored.After the continuous renal replacement therapy for renal failure was administered and other conservative treatments were given for the complications after the CPR with thrombolytic therapy, she finally recovered and was discharged. This case report supports the use of persistent ongoing CPR efforts and the use of thrombolytic therapy.