Cardiac thrombus formation during cardiopulmonary resuscitation for cardiac arrest: Is it time for ultrasound-enhanced algorithms?

Current guidelines consider thrombosis as a potential (and reversible) cause of cardiorespiratory arrest (CA). However, cardiac thrombus formation (TF) is likely to be the consequence of the forward blood flow ceasing during cardiac standstill. We present the case of a young man who was hospitalized for infective endocarditis, complicated by multiorgan disease and sudden CA on the 5th day. Prompt cardiopulmonary resuscitation (CPR) warranted a return of spontaneous circulation in 16 min but, unexpectedly, a TF was recognized in the right atrium at echocardiography. The blood clot resolved with rapid administration of endovenous heparin and continued chest compressions. Even though cardiac ultrasound is not ready for a routine use during CPR, the present study confirms a key role in the management of CA patients.