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{
    "pk": 502,
    "title": "Central Venous Catheter-directed Tissue Plasminogen Activator in Massive Pulmonary Embolism",
    "subtitle": null,
    "abstract": "We present the case of an 88-year-old female who presented to the emergency department (ED) with suspected massive pulmonary embolism (PE) causing respiratory failure, right heart strain, and shock, who despite early and aggressive resuscitation with vasopressors and continuous peripheral infusion of tissue plasminogen activator (tPA), suffered a cardiac arrest in the ED. We describe the approach of a tPA bolus directed through a central venous catheter, resulting in return of spontaneous circulation and immediate improvement in physiologic parameters prior to confirmation of PE with computed tomography angiogram. We further hypothesize that in patients deemed too unstable to be transferred for embolectomy or catheter-directed thrombolysis, central venous catheter-directed bolus tPA may be more effective than peripheral infusion alone.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2t77g6kt",
    "frozenauthors": [
        {
            "first_name": "Vishal",
            "middle_name": "",
            "last_name": "Gulati",
            "name_suffix": "",
            "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        },
        {
            "first_name": "Jared",
            "middle_name": "",
            "last_name": "Brazg",
            "name_suffix": "",
            "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        }
    ],
    "date_submitted": "2018-01-06T00:16:07+05:30",
    "date_accepted": "2018-01-06T00:16:07+05:30",
    "date_published": "2018-01-18T23:42:51+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/502/galley/266/download/"
        }
    ]
}