In suspected massive pulmonary embolism causing arrest, which thrombolysis option may be considered if not contraindicated?

In suspected massive pulmonary embolism causing arrest, which thrombolysis option may be considered if not contraindicated?

• A. Heparin infusion
• B. Local catheter-directed thrombolysis
• C. Systemic thrombolysis (e.g., tPA)
• D. No thrombolysis

Answer: (C)

In massive pulmonary embolism with arrest, the priority is rapidly restoring pulmonary perfusion to relieve the obstructed flow and support the right heart. Thrombolysis dissolves the clot quickly, and giving a systemic fibrinolytic agent like tPA delivers treatment throughout the circulation, reaching central and large emboli fast. This rapid reperfusion during resuscitation improves chances of return of spontaneous circulation and survival when there are no absolute contraindications. Anticoagulation with heparin helps prevent new clots but does not quickly dissolve the existing massive clot, so it isn’t sufficient as the primary reperfusion strategy in this urgent scenario. Catheter-directed thrombolysis can be considered when systemic thrombolysis is contraindicated or not feasible, but systemic therapy is typically preferred for rapid effect during arrest, provided there are no contraindications. No thrombolysis would leave the obstruction unresolved and is not appropriate here.

In massive pulmonary embolism with arrest, the priority is rapidly restoring pulmonary perfusion to relieve the obstructed flow and support the right heart. Thrombolysis dissolves the clot quickly, and giving a systemic fibrinolytic agent like tPA delivers treatment throughout the circulation, reaching central and large emboli fast. This rapid reperfusion during resuscitation improves chances of return of spontaneous circulation and survival when there are no absolute contraindications. Anticoagulation with heparin helps prevent new clots but does not quickly dissolve the existing massive clot, so it isn’t sufficient as the primary reperfusion strategy in this urgent scenario. Catheter-directed thrombolysis can be considered when systemic thrombolysis is contraindicated or not feasible, but systemic therapy is typically preferred for rapid effect during arrest, provided there are no contraindications. No thrombolysis would leave the obstruction unresolved and is not appropriate here.