Zusammenfassung
Die Behandlung massiver, reanimationspflichtiger Lungenembolien mit Thrombolytika ist eine Therapieoption in dieser dramatischen Situation. Dies ist der erste Bericht über den erfolgreichen Einsatz einer Bolusgabe des Thrombolytikums Tenecteplase bei einer 61-jährigen Frau, die eine fulminante Lungenembolie mit einstündiger Reanimation ohne Blutungskomplikationen oder neurologische Defizite überlebte. Der schnelle und einfach zu handhabende Einsatz eines modernen Thrombolytikums ist eine Therapieoption, die so lange nicht unversucht bleiben sollte, bis kontrollierte Studien diese Beobachtungen an ausreichend großen Patientenkollektiven bestätigen oder widerlegen.
Abstract
The use of thrombolytics in patients with massive pulmonary embolism and cardiopulmonary resuscitation is a treatment option in this dramatic situation. This is the first report about the successful use of a bolus administration of the thrombolytic tenecteplase in a 61-year-old woman. This patient survived a 1-hour cardiopulmonary resuscitation without bleeding complications and neurologic deficits. The rapid and simple-to-use administration of a modern thrombolytic is a treatment option, which may be used as long as randomized clinical trials in sufficiently sized patient populations will confirm or refute these observations.
Schlüsselwörter
Lungenembolie - kardiopulmonale Reanimation - Thrombolyse - Tenecteplase
Key words
Pulmonary embolism - cardiopulmonary resuscitation - thrombolysis - tenecteplase
-
1
Padosch S A, Motsch J, Boettiger B W.
Thrombolyse während der kardiopulmonalen Reanimation.
Anaesthesist.
2002;
51 (7)
516-532
-
2
Grabner C, Wahl U, Reineke H.
Erfolgreiche kardiopulmonale Reanimation durch hoch dosierte Bolusinjektion von rt-PA bei fulminanter Lungenembolie.
Anasthesiol Intensivmed Notfallmed Schmerzther.
2001;
36 (5)
306-308
-
3
Boettiger B W, Reim S M, Diezel G.
Erfolgreiche Behandlung einer fulminanten Lungenembolie durch hoch dosierte Bolusinjektion von Urokinase während der kardiopulmonalen Reanimation.
Anasthesiol Intensivmed Notfallmed Schmerzther.
1991;
26 (1)
29-36
-
4
Boettiger B W, Reim S M, Diezel G, Boehrer H, Martin E.
High-dose bolus injection of urokinase. Use during cardiopulmonary resuscitation for massive pulmonary embolism.
Chest.
1994;
106 (4)
1281-1283
-
5
Boettiger B W, Boehrer H, Bach A, Motsch J, Martin E.
Bolus injection of thrombolytic agents during cardiopulmonary resuscitation for massive pulmonary embolism.
Resuscitation.
1994;
28 (1)
45-54
-
6
Newman D H, Greenwald I, Callaway C W.
Cardiac arrest and the role of thrombolytic agents.
Ann Emerg Med.
2000;
35 (5)
472-480
-
7
Oneglia C, Rusconi C.
Successful thrombolysis with rt-PA after syncope and protracted cardiopulmonary resuscitation in massive pulmonary embolism.
Cardiovasc Drugs Ther.
1997;
11 (3)
509-511
-
8
Schulte-Sinkus D, Standl T.
Erfolgreiche Reanimation nach Bolusinjektion von Gewebe-Plasminogenaktivator in der Notaufnahme.
Anasthesiol Intensivmed Notfallmed Schmerzther.
1998;
33 (2)
124-128
-
9
Kuisma M, Silfvast T, Voipio V, Malmstrom R.
Prehospital thrombolytic treatment of massive pulmonary embolism with reteplase during cardiopulmonary resuscitation.
Resuscitation.
1998;
38 (1)
47-50
-
10
Sigmund M, Rubart M, Dahl J vom, Uebis R, Hanrath P.
Successful Treatment of Massive Pulmonary Embolism by Combined Mechanical and Thrombolytic Therapie.
J Interv Cardiol.
1991;
(1)
63-68
-
11
Caldicott D, Parasivam S, Harding J, Edwards N, Bochner F.
Tenecteplase for massive pulmonary embolus.
Resuscitation.
2002;
55 (2)
211-213
-
12
Sze D Y, Carey M B, Razavi M K.
Treatment of massive pulmonary embolus with catheter-directed tenecteplase.
J Vasc Interv Radiol .
2001;
12 (12)
1456-1457
-
13
Goldhaber S Z.
Pulmonary embolism.
N Engl J Med.
1998;
339 (2)
93-104
-
14
Boettiger B W, Grabner C, Bauer H. et al .
Long-term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a mid-sized urban/suburban area.
Heart.
1999;
82
1674-1679
-
15
Silfvast T.
Cause of death in unsuccessful prehospital resuscitation.
J Intern Med.
1991;
229 (4)
331-335
-
16
Spaulding C M, Joly L M, Rosenberg A. et al .
Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.
N Engl J Med.
1997;
336 (23)
1629-1633
-
17
Zipes D P, Wellens H J.
Sudden cardiac death.
Circulation.
1998;
98 (21)
2334-2351
-
18
Goldhaber S Z, Rosa M de, Visani L.
International cooperative pulmonary embolism registry detects a high mortality rate.
Circulation.
1997;
96, Suppl I
885
-
19
Jerjes-Sanchez C, Ramirez-Rivera A, Lourdes-Garcia M de. et al .
Streptokinase and Heparin versus Heparin Alone in Massive Pulmonary Embolism: A Randomized Controlled Trial.
J Thromb Thrombolysis.
1995;
2 (3)
227-229
-
20
Stein P D, Hull R D, Raskob G.
Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Consideration of noninvasive management.
Ann Intern Med.
1994;
121 (5)
313-317
-
21
Goldhaber S Z.
Thrombolysis in pulmonary embolism: a debatable indication.
Thromb Haemost.
2001;
86 (1)
444-451
-
22
Boettiger B W, Martin E.
Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest.
Curr Opin Crit Care.
2001;
7 (3)
176-183
-
23
Boettiger B W, Bode C, Kern S. et al .
Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial.
Lancet.
2001;
357 (9268)
1583-1585
-
24
Keyt B A, Paoni N F, Refino C J. et al .
A faster-acting and more potent form of tissue plasminogen activator.
Proc Natl Acad Sci U S A.
1994;
91 (9)
3670-3674
-
25
Refino C J, Paoni N F, Keyt B A. et al .
A variant of t-PA (T103N, KHRR 296 - 299 AAAA) that, by bolus, has increased potency and decreased systemic activation of plasminogen.
Thromb Haemost.
1993;
70 (2)
313-319
-
26
Collen D, Stassen J M, Yasuda T. et al .
Comparative thrombolytic properties of tissue-type plasminogen activator and of a plasminogen activator inhibitor-1-resistant glycosylation variant, in a combined arterial and venous thrombosis model in the dog.
Thromb Haemost.
1994;
72 (1)
98-104
-
27
Benedict C R, Refino C J, Keyt B A. et al .
New variant of human tissue plasminogen activator (TPA) with enhanced efficacy and lower incidence of bleeding compared with recombinant human TPA.
Circulation.
1995;
92 (10)
3032-3040
-
28
Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial .
Assessment of the Safety and Efficacy of a New Thrombolytic Investigators.
Lancet.
1999;
354 (9180)
716-722
Dr. med. A. Fischbach
Zentrum Innere Medizin · Innere Medizin I Kardiologie/Angiologie · Dr.-Horst-Schmidt-Kliniken GmbH
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