Code, PE and tPA route

Q: In patients with Cardio-pulmonary arrest due to massive pulmonary embolism (PE) thrombolytic therapy is preferred via 

A) Central  Venous Catheter (CVC)
B) Peripheral catheter (PV)


Answer: A

Usually, thrombolytic therapy (tissue Plasminogen Activator - tPA) in PE is given via peripheral venous catheter to avoid bleeding from puncture sites, but if thrombolytic therapy is used during cardiopulmonary arrest due to PE, it is preferred to use CVC. If CVC is not available, ideally should be quickly inserted under ultrasound to avoid multiple punctures.

Patients in cardiac arrest have poor peripheral perfusion as well as right-sided heart failure, which may limit the efficacy of thrombolytic therapy. Also, it is suggested that a bolus dose of thrombolytic therapy through the CVC increases the concentration of the drug at the site of the thrombus, quickly resolving the embolism.

#pulmonary
#procedure
#hemodynamic


References: 

1. Gulati V, Brazg J. Central Venous Catheter-directed Tissue Plasminogen Activator in Massive Pulmonary Embolism. Clin Pract Cases Emerg Med. 2018;2(1):67-70. 

2. Pillarisetti J, Gupta K. Massive pulmonary embolism with shock: role of thrombolysis using central venous access. J Invasive Cardiol. 2012;24(12):E321–4