Thrombolysis during cardiopulmonary resuscitation in fulminant pulmonary embolism: a review.

OBJECTIVE: To review current knowledge on thrombolysis in patients with fulminant pulmonary embolism (FPE) who need cardiopulmonary resuscitation (CPR). DATA SOURCES: The bibliography for the study was compiled through a search of different databases between 1966 and 2000. References cited in the articles selected were also reviewed. STUDY SELECTION: The selection criteria included all reports published on thrombolysis, pulmonary embolism, and CPR, from case reports and case series to controlled studies. DATA SYNTHESIS: Very few studies evaluated thrombolysis in cases of FPE that required CPR and most of these were clinical case reports and case series with a low level of scientific evidence. There has been no clinical trial to address this issue.
CONCLUSIONS: FPE can frequently produce cardiac arrest, which has an extremely high mortality despite application of the usual CPR measures. The administration of thrombolytic therapy during CPR could help to reduce the mortality, although it has classically been contraindicated. There are no published clinical trials or other high-grade studies that evaluated the efficacy and safety of this approach. From the few existing studies, it can be inferred that thrombolysis may be efficacious and safe for patients with FPE who need CPR. However, a clinical trial is required to provide evidence of value for sound clinical decision-making.