OUT-OF-HOSPITAL CARDIAC ARREST COMPLICATED WITH ANTERIOR SPINAL ARTERY SYNDROME

Background and objective: The success rate of thrombolytic therapy for patients with ultralong cardiac arrest caused by pulmonary embolism (PE) has been increasing. Thrombolytic timing to reduce the risk of bleeding is critical in preventing anterior spinal artery syndrome (ASAS). Methods: This is a case report of an out-of-hospital cardiac arrest (OHCA) caused by massive PE caused to a patient who received thrombolytic therapy after 140 min of pre-hospital cardiopulmonary resuscitation (CPR). Results: A 51-year-old female was admitted to the emergency department due to an OHCA, presenting with no vital signs. After 140 min of CPR, vital signs remained unstable, so thrombolytic therapy with 50-mg Alteplase was performed, spontaneously improving circulation. After admission to the ICU, the muscle strength of the lower limbs was 0 and both shallow and deep reflexes disappeared. After discharge, there was no improvement in the lower limbs at the six-month follow-up. A search of the PubMed database identified 13 cases of OHCA caused by PE who underwent in-hospital CPR before thrombolytic therapy for 2–150 min, with an 8% incidence of ASAS and a 50% recovery rate. Conclusion: Ultralong CPR for patients with cardiac arrest caused by PE does not affect the outcome of thrombolytic therapy. However, it is necessary to identify these patients early and perform thrombolytic therapy to prevent the complications of CPR as well as the injury to the upper motor neurons caused by thrombosis.