Successful thrombolysis guided by focused echocardiography (FoCUS) during cardiac arrest secondary to massive pulmonary embolism: case report

Abstract

Systemic thrombolysis during cardiac arrest for massive pulmonary embolism (PE) remains a challenge due to its limited clinical evidence and controversies about its long-term benefits. This report describes the case of a 65-year-old patient with massive PE and severe hemodynamic deterioration, where focused cardiac ultrasound (FoCUS) played an essential role in identifying critical findings such as right ventricular dilatation, McConnell’s sign, and reduced inspiratory collapse of the inferior vena cava. These findings guided the decision to administer systemic thrombolysis with alteplase, achieving a successful return to spontaneous circulation and a favorable clinical recovery without neurological sequelae. This case highlights the strengths of FoCUS in critical scenarios, underlining its role as a diagnostic and therapeutic tool in situations where other methods are not feasible. It emphasizes the need for further research to optimize its implementation and standardize protocols in critical care medicine.
Keywords: Pulmonary Embolism; Thrombolytic Therapy; Ultrasonography