Key result
Alteplase followed by mechanical thrombectomy achieves full recovery in massive PE with multiple cardiac arrests.
Why the study?
Massive PE with obstructive shock has a poor prognosis due to diagnostic challenges, as nonspecific signs and confounding factors such as seizures can obscure the diagnosis.
Case Report (n=1)
No
Timely administration of systemic thrombolysis and mechanical thrombectomy, guided by strong clinical suspicion and point-of-care ultrasound, can lead to full recovery in massive pulmonary embolism presenting atypically with seizures and multiple cardiac arrests.
High suspicion with POCUS may enable reperfusion success in atypical massive PE; hypothesis-generating and should not yet change practice.
Massive pulmonary embolism (PE) with obstructive shock is a life-threatening condition associated with poor prognosis, primarily due to diagnostic challenges. Clinical presentation is often nonspecific, beyond the classic signs of shock, and confounding factors, such as seizures secondary to cerebral hypoperfusion, as observed in this case, may further obscure the diagnosis. We report the case of a 54-year-old male patient brought to the ED by the mobile emergency and resuscitation service following recurrent seizures associated with refractory hypotension. Given the rapid clinical deterioration and multiple cardiac arrests, an underlying cause was urgently sought. After ruling out common etiologies such as sepsis and acute coronary syndrome, massive PE was strongly suspected based on bedside point-of-care echocardiography findings, elevated D-dimer levels, and high clinical suspicion. Systemic thrombolysis (alteplase) was administered directly in the ED, leading to hemodynamic stabilization. The diagnosis was later confirmed via contrast-enhanced thoracic CT, and the patient subsequently underwent mechanical thrombectomy, resulting in complete recovery. He was extubated and regained full consciousness on the same day. This case illustrates how timely management guided by strong clinical suspicion can lead to full recovery without sequelae. It also emphasizes the critical importance of minimizing no-flow time to achieve optimal outcomes.
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Martins et al. (2026) conducted a case report in 54-year-old male patient with massive pulmonary embolism presenting as recurrent seizures and refractory hypotension with multiple cardiac arrests (n=1). Systemic thrombolysis with alteplase followed by mechanical thrombectomy was evaluated on Survival and full recovery without sequelae after massive pulmonary embolism with obstructive shock and multiple cardiac arrests. Systemic thrombolysis with alteplase followed by mechanical thrombectomy led to full recovery without sequelae in a 54-year-old male with massive pulmonary embolism presenting with recurrent seizures and multiple cardiac arrests.
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