• Am J Emerg Med · Sep 2019

    Case Reports

    Multiple boluses of alteplase followed by extracorporeal membrane oxygenation for massive pulmonary embolism.

    • Irene Li, Arielle Filiberti, Robert Mokszycki, and Gayle Galletta.
    • UMass Memorial Medical Center, Department of Pharmacy, Worcester, MA, United States of America. Electronic address: Irene.li@umassmemorial.org.
    • Am J Emerg Med. 2019 Sep 1; 37 (9): 1808.e5-1808.e6.

    AbstractThrombolytics and extracorporeal membrane oxygenation (ECMO) are potential management options for massive pulmonary embolism (PE). There are early data supporting the use of repeated alteplase 50 mg bolus for massive PE. However, there is sparse literature addressing placement of ECMO catheters after systemic thrombolysis, and there are no reports of initiating ECMO after repeated bolus of alteplase. We present the case of a patient with massive PE who received two boluses of alteplase for recurrent cardiac arrest, followed by initiation of ECMO. The patient stabilized with these interventions, and ultimately had a good outcome with normal neurologic and functional status.Copyright © 2019 Elsevier Inc. All rights reserved.

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