CHEST Guidelines-Response_chest

Response_chest_23 (1)

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The document is a collection of correspondence and responses regarding cardiopulmonary resuscitation (CPR) in the context of patients with pulmonary embolism (PE). Dr. Carla Nobre and Dr. Boban Thomas emphasize the importance of prolonged CPR in conjunction with thrombolytics, such as tenecteplase, for patients with PE experiencing cardiopulmonary arrest. They argue that continued chest compressions are vital even if there is a return of spontaneous circulation (ROSC) to ensure adequate cardiac output and to help the thrombolytic agent work effectively.<br /><br />The response from Dr. Boulos Nassar acknowledges the potential benefits of prolonged CPR and thrombolytic therapy. However, Dr. Nassar highlights the ambiguity in guidelines by organizations like the American Heart Association (AHA) regarding the minimum duration for resuscitation. Emerging evidence suggests that prolonged resuscitation could be advantageous, but specific indicators such as end-tidal CO2 and diastolic blood pressure should guide the decision to continue CPR. Additionally, while thrombolytics may offer benefits in PE-related cardiac arrest, challenges remain in diagnosing PE swiftly and managing risks like bleeding during chest compressions.<br /><br />New advancements, such as bedside ultrasonography and extracorporeal CPR, are mentioned as improving diagnostic capabilities in resuscitation scenarios. While current guidelines offer moderate recommendations for thrombolysis in confirmed PE cases, they suggest a weaker stance for suspected cases due to the paucity of strong evidence and logistical challenges. Overall, the correspondence underscores a need for refined guidelines and further research to determine the best practices for managing PE in cardiac arrest scenarios.

Keywords

cardiopulmonary resuscitation

pulmonary embolism

thrombolytics

tenecteplase

spontaneous circulation

American Heart Association

end-tidal CO2

bedside ultrasonography

extracorporeal CPR

resuscitation guidelines