Javaudin et al. [1] recommended that for cases of out-ofhospital cardiac arrest (OHCA) for which a cause is not obvious, pulmonary embolism (PE) should be suspected if the initial rhythm is nonshockable and there is a history of thromboembolism (TE). In accordance with the guidelines of the American Heart Association, these patients could be treated with systemic thrombolysis (ST) during resuscitation (low level of evidence) [1]. We would like to add some comments. First, recent studies have shown that ultrasound-facilitated catheter fibrinolysis relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial hemorrhage than historical rates with ST [2]. However, further research is required to determine the optimal application of this technique in the setting of acute PE [2]. Second, the insertion of an emergency veno-arterial extracorporeal membrane oxygenation (VA-ECMO) catheter should be considered before starting ST. VA-ECMO can be a lifesaving therapeutic consideration, either as an adjunct to definitive management strategies (surgical/catheter embolectomy, thrombolysis) or on its own [3]. According to a recent systematic review, VAECMO for selected patients with massive PE is associated with good outcome [3]. Third, after failure of thrombolysis, surgical embolectomy or catheter embolectomy should be considered in selected centers [3]. Fourth, published cases of thrombolysis for massive PE during pregnancy and the postpartum

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肺栓塞相关院外心脏骤停复苏期间的溶栓治疗：可能不是每个人的理想解决方案

贾瓦丁等人。[1] 建议对于原因不明显的院外心脏骤停 (OHCA) 病例，如果初始心律不可电击且有血栓栓塞 (TE) 病史，则应怀疑肺栓塞 (PE)。根据美国心脏协会的指南，这些患者可以在复苏期间接受全身溶栓 (ST) 治疗（低证据水平）[1]。我们想补充一些意见。首先，最近的研究表明，超声促进导管纤溶可减轻右心室压力超负荷，与 ST 的历史发生率相比，大出血和颅内出血的风险更低 [2]。然而，需要进一步研究以确定该技术在急性 PE 中的最佳应用 [2]。第二，在开始 ST 之前，应考虑插入紧急静脉-动脉体外膜肺氧合 (VA-ECMO) 导管。VA-ECMO 可以是一种挽救生命的治疗考虑，既可以作为确定性管理策略（手术/导管取栓、溶栓）的辅助手段，也可以单独使用 [3]。根据最近的一项系统评价，针对选定的大面积 PE 患者进行 VAECMO 与良好的结果相关 [3]。第三，在溶栓失败后，应在选定的中心考虑手术取栓或导管取栓[3]。四、已发表的孕产期大面积PE溶栓病例 无论是作为确定性管理策略（手术/导管取栓、溶栓）的辅助手段，还是单独使用 [3]。根据最近的一项系统评价，对选定的大面积 PE 患者进行 VAECMO 与良好的结果相关 [3]。第三，在溶栓失败后，应在选定的中心考虑手术取栓或导管取栓[3]。四、已发表的孕产期大面积PE溶栓病例 无论是作为确定性管理策略（手术/导管取栓、溶栓）的辅助手段，还是单独使用 [3]。根据最近的一项系统评价，对选定的大面积 PE 患者进行 VAECMO 与良好的结果相关 [3]。第三，在溶栓失败后，应在选定的中心考虑手术取栓或导管取栓[3]。四、已发表的孕产期大面积PE溶栓病例