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Reminder of important clinical lesson
Case report
Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy
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  1. John Edward Ashbridge Taylor1,
  2. Chen Wen Ngua1 and
  3. Matthew Carwardine2
  1. 1Emergency Unit, University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
  2. 2Anaesthetics, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, UK
  1. Correspondence to Dr John Edward Ashbridge Taylor; john.taylor34{at}nhs.net

Abstract

Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.

  • resuscitation
  • obstetrics and gynaecology
  • pulmonary embolism

https://doi.org/10.1136/bcr-2019-234083

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    Footnotes

    • Contributors JEAT, CWN and MC formed the medical team undertaking the resuscitation of the reported case. The manuscript was written jointly by JEAT, CWN and MC. The literature review was undertaken by JEAT, CWN and MC. Each author has given final approval of the version to be published and has agreed to be accountable for all aspects of the work. JEAT performed the literature search, co-authored the manuscript, edited and made corrections, wrote the cover letter and is responsible for submitting the manuscript. CWN performed the literature search and co-authored the manuscript. MC created the case timeline (figure 1), performed the literature search and co-authored the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.