Impact of rescue-thrombolysis during cardiopulmonary resuscitation in patients with pulmonary embolism

Abstract

Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE.

Methodology/principal findings: We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.6+/-1.2 min versus 24.6+/-0.8 min; p<0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.0+/-1.3 vs. 22.5+/-0.9 min; p<0.001).

Conclusion: Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.

Figure 1. Time-outcome relation.

Time of thrombolysis onset, CPR time after thrombolysis and total CPR duration in patients with and without successful CPR (A), in patients with hospital discharge vs. those who died (B), and in patients with hospital discharge versus those with secondary lethality after initially successful CPR.

Figure 2. Effect of the time until thrombolysis onset on outcome.

(A) Time dependent ROSC, (B) time dependent successful hospital discharge.