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Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism
  1. Mario Valdés1,
  2. Pilar Araujo2,
  3. Carmen de Andrés1,
  4. Eva Sastre1,
  5. Terence Martin3
  1. 1SUMMA 112, Madrid, Spain
  2. 2La Paz Hospital, Madrid, Spain
  3. 3Royal Hampshire County Hospital, Winchester, UK
  1. Correspondence to Dr T E Martin, Anaesthetic Department MP 25, Royal Hampshire County Hospital, Winchester SO22 5DG, UK; Terry.Martin{at}


Pulmonary thromboembolism has an incidence of more than 69/100 000 population but may be underdiagnosed because of the non-specific character of its symptoms and difficult differential diagnosis. The prognosis is worse if the pulmonary thromboembolism is massive and associated with haemodynamic instability, whereupon mortality rises to over 50%. Cardiogenic shock supervenes and cardiopulmonary arrest is often inevitable. This emergency can only be prevented by aggressive therapy with thrombolytic agents. The case history is described of a 25-year-old woman in cardiogenic shock leading to prehospital cardiac arrest in which intravenous access was impossible. Resuscitation drugs were given by the intraosseous route and, with a suspected diagnosis of massive pulmonary thromboembolism, it was decided to start thrombolysis by the same route before transport to hospital. The treatment was a complete success, and the patient was discharged from hospital with no sequelae after 39 days.

  • Pulmonary embolism
  • thrombo-embolic disease
  • prehosptal care
  • thrombolysis
  • helicopter retrieval

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  • Competing interests None

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.