TEP de alto riesgo: abordaje intervencionista que salva vidas. Reporte de caso y revisión de literatura

We report the case of a young patient admitted to our institution after suffering cardiac arrest (asystole) and being resuscitated for 15 minutes, under invasive mechanical ventilation, with hemodynamic lability and atrial fibrillation rhythm with rapid ventricular response upon admission. Among the potential causes of cardiac arrest, pulmonary thromboembolism and drug abuse were suspected (due to not knowing the exact history of the referral site), POCUS was performed with evidence of significant right ventricular involvement and negative CUS at that time for DVT, so cardiac involvement was confirmed with formal transthoracic echocardiogram and urgent chest angiotomography, which showed bilateral involvement of lobar and segmental branches. In this context, massive PTE is considered with indication for thrombolytic management according to current management guidelines, however, given the availability in the institution of invasive procedure, partial thrombectomy is performed by aspiration reducing the thrombotic load and intra-arterial infusion thrombolysis is left (Seattle Protocol), through a catheter in the trunk of the pulmonary artery, in addition to infusion of unfractionated heparin. The clinical evolution of the patient was favorable, with initial stay in ICU for 3 days and subsequent discharge to general hospitalization where oral anticoagulation with DOAC was defined in view of the negative profile for SAF. In this way we demonstrate a form of intensive management of an increasingly frequent and potentially fatal pathology, mitigating the risks associated with systemic thrombolysis such as intracerebral bleeding, which can occur in up to 10% of cases.