Successful resuscitation with thrombolysis of pulmonary embolism due to thrombotic thrombocytopenic purpura during cardiac arrest.

Our case describes an episode of fulminant pulmonary embolism (PE) due to thrombotic thrombocytopenic purpura, which was accompanied by cardiac arrest. A 33-year-old woman was transferred to intensive care unit who had severe dyspnea with microangiopathic hemolytic anemia. After intubated with ventilation support, the patient’s symptoms were exacerbated with cardiac arrest from the narrow QRS complex pulseless electrical activity. With an initially unsuccessful cardiopulmonary resuscitation period of 56 minutes, spontaneous circulation returned after a bolus injection of recombinant tissue plasminogen activator. The patient became awake and alert without any complication and sequel through successive treatment. We conclude that thrombotic thrombocytopenic purpura is a medical emergency with severe hematologic disorder with a high risk of PE especially within 24 hours after the episodes of hemolysis. Empiric thrombolysis during cardiopulmonary resuscitation in presumed fulminant PE can be highly beneficial with better survival rates and neurologic outcome.