Trombólisis intraparo en tromboembolia pulmonar masiva / Thrombolysis during cardiopulmonary resuscitation in massive pulmonary embolism

RESUMEN

Resumen La tromboembolia pulmonar forma parte de la enfermedad tromboembólica venosa, junto con la trombosis venosa profunda. Es una patología de alta morbimortalidad, principalmente si no se diagnostica y/o trata de manera oportuna. El diagnóstico es difícil debido a su presentación clínica variable y poco específica. En el contexto de tromboembolia pulmonar de alto riesgo, que se presenta como una condición que amenaza la vida y requiere intervención inmediata para impactar el pronóstico del paciente, la trombólisis constituye una alternativa en quienes cursen con inestabilidad hemodinámica o incluso parada cardiaca, que no tengan contraindicaciones para su realización. Se presenta el caso de un hombre de 54 años quien consultó al servicio de urgencias tras presentar síncope y posteriormente dolor torácico, precedido por 15 días de dolor y edema en pantorrilla. Sufrió deterioro y evolucionó a parada cardiopulmonar. Se diagnosticó tromboembolia pulmonar de alto riesgo mediante ecocardiograma; se iniciaron maniobras de reanimación y, de manera paralela, se administró trombolítico. Posteriormente, respondió de manera satisfactoria a la terapia.

ABSTRACT

Abstract Pulmonary thromboembolism (PE) is part of venous thromboembolic disease, along with deep venous thrombosis (DVT). It has a high morbidity and mortality, particularly if it is not diagnosed and / or treated in a timely manner. The diagnosis is difficult due to its variable and unspecific clinical presentation. In the context of high-risk PE, which presents as a life-threatening condition and requires immediate intervention to have an impact on the prognosis of patients, thrombolysis is an alternative in those with haemodynamic instability or even cardiac arrest, if they have no contraindications for performing this. The case is presented of a 54 year old man who consulted in the emergency department after presenting with syncope followed by chest pain, preceded by 15 days of pain and oedema in the calf. The patient deteriorated rapidly, evolving to cardiopulmonary arrest. A high-risk PE was diagnosed by echocardiography, resuscitation manoeuvres were initiated, and thrombolytic therapy given in parallel. Subsequently the patient had a satisfactory outcome with the therapy.