Acute Respiratory Failure from Neck Hematoma following Venous Cannulation in a Patient Receiving Streptokinase

Abstract

I present a case of acute respiratory failure, caused by hematoma in the neck that led to compression of the upper airway and possible cerebral ischemia. A few hours after the patient with acute myocardial infarction had been treated with intravenous systemic infusion of streptokinase, heparin, and oral acetylsalicylic acid, several attempts were made to gain intravenous access by percutaneous puncture of the internal jugular vein, guided by external anatomic landmarks. A large hematoma developed in the neck, causing acute respiratory failure. The patient's condition was detected during close monitoring, and the patient was treated in time by orotracheal intubation and mechanical ventilation. Intravenous heparin was discontinued, and red blood cells and fresh frozen plasma were transfused. The main goal of thrombolytic therapy—reperfusion with early peak of creatine kinase was not achieved. The case suggests that in the first few hours after treatment of acute myocardial infarction with systemic intravenous thrombolytic therapy, the hemostatic defect that develops increases the risk for bleeding after percutaneous puncture of internal jugular vein. The procedure is safer when it is performed with caution by the most skillful and experienced operator and after prior ultrasonic examination of the neck anatomy in order to avoid several puncture attempts and the increased likelihood of abundant hemorrhage at the puncture sites. Close monitoring is essential to identify and treat any potential life-threatening complication.