Key result
Reteplase administration led to a dramatic improvement and successful extubation in a 30-year-old woman with massive pulmonary embolism one day after recent surgery.
Case Report (n=1)
Reteplase can be a life-saving intervention for massive pulmonary embolism presenting with cardiac arrest, even in the immediate post-operative period.
Supports reteplase consideration in select post-op massive PE arrest; hypothesis-generating and requires prospective validation.
We describe a case of sudden and severe pulseless electrical activity in a 30 year old woman which was managed successfully with reteplase and heparin one day following an anterior cruciate ligament repair. The presentation of a sudden collapse with ECG findings of S1Q3T3, early precordial lead ST depression and partial right bundle branch block were indicative of an acute pulmonary embolus. The cardiopulmonary collapse necessitated rapid treatment in the absence of confirmatory investigations. Reteplase (10 U stat followed by 10 U at 30 minutes) led to a dramatic improvement in the cardiovascular status of the patient. One day following the cardiac arrest the patient was extubated and responding normally. A spiral CT performed later confirmed multiple small embolic defects in the lower pulmonary arteries of both lower lung zones. This case highlights the utility of reteplase in the management of an acute pulmonary embolism and in an emergency, recent surgery is not necessarily a contraindication to its use.
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Theron et al. (2000) conducted a case report in Massive Pulmonary Embolism (n=1). Reteplase and heparin was evaluated on Cardiovascular status improvement. Reteplase administration led to a dramatic improvement and successful extubation in a 30-year-old woman with massive pulmonary embolism one day after recent surgery.
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