Continous right ventricular monitoring under lysis with rt-PA in acute pulmonary embolia

Introduction

During postsurgical treatment on our ICU by six patients occurred an acute lung embolia Grade III/IV. Right after resuscitation we placed prior to angiography a Swan-Ganz-Catheter with SVO₂ in a pulmonary arteria. Typical signs of a lung embolia like increased PAP, PCWP and decreased SVO₂ and CO were obtained. We used the right-ventricular monitoring during lysis with rt-PA.

Methods and patients

Six patients with average age of 68.3 were monitored. Prior to embolia none of the patients had insufficient heart function or irregular heart rhythms. After resuscitation all patients showed increased PAP_sys higher than 50 mmHg, CI lower than 2.5 and SVO₂ lower than 75%. All patients were treated with administration of rt-PA in fraction of 5 mg each 90 s. Success of lysis was shown by angiography and right-ventricular monitoring.

Results

By four patients there was a rapid normalisation after administration of highest 15 mg rt-PA. The result was to be seen first at angiography than on SVO₂. Cardiac parameters took 5–8 min to normalize. One patient needs administration of 40 mg rt-PA for normalization. One patient died during lysis without any remarkable normalization and after unsuccessful resuscitation.

Discussion

It was shown that continous right-ventricular monitoring is a capable feature for monitoring during lysis at thecritically ill patient. Even angiography is more sensitive the SVO₂-monitoring provides usefull information. If there is no way to have an angiography, right-ventricular monitoring is a valuable system. Placement of catheters can easily be performed and is even in unstable patients practicable.