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. 2021 Feb 22:13:67-73.
doi: 10.2147/OAEM.S275767. eCollection 2021.

Emergency Thrombolysis During Cardiac Arrest Due to Pulmonary Thromboembolism: Our Experience Over 6 Years

David de Paz  1   2   3   4 , Julio Diez  1 , Fredy Ariza  2 , Diego Fernando Scarpetta  1   2   3   4   5 , Jaime A Quintero  1   2   3 , Sandra Milena Carvajal  1
Affiliations

Emergency Thrombolysis During Cardiac Arrest Due to Pulmonary Thromboembolism: Our Experience Over 6 Years

David de Paz et al. Open Access Emerg Med. .

Abstract

Introduction: Cardiac arrest (CA) is one of the leading causes of death worldwide. Among patients with CA, pulmonary embolism (PE) accounts for approximately 10% of all cases.

Objective: To compare the outcomes after cardiopulmonary-cerebral resuscitation (CCPR) with and without thrombolytic therapy (TT) in patients with CA secondary to PE.

Methods: We included patients older than 17 years admitted to our hospital between 2013 and 2017 with a diagnosis of CA with confirmed or highly suspected PE who received CCPR with or without TT. Measures of central tendency were used to depict the data.

Results: The study comprised 16 patients, 8 of whom received CCPR and thrombolysis with alteplase, whereas the remaining patients received CCPR without TT. The most frequent rhythm of CA in both groups was pulseless electrical activity. Return of spontaneous circulation (ROSC) occurred in 100% of patients who received TT and in 88% of non-thrombolysed patients. The mortality rate of patients who received TT and non-thrombolysed patients at 24 hours was 25% and 50%, respectively. However, at the time of hospital discharge, the mortality was the same in both groups (62%). In patients who received TT, mortality was related to sepsis and hemorrhage whereas in non-thrombolysed patients, mortality was due to myocardial dysfunction.

Conclusion: Intra-arrest thrombolysis resulted in a higher likelihood of ROSC and a higher 24-hour survival in adults with CA secondary to acute PE. Overall, the survival at hospital discharge was the same in the two groups.

Keywords: cardiac arrest; pulmonary embolism; return of spontaneous circulation.

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Conflict of interest statement

Fredy Ariza report honoraries for scientific consultation from Octapharma, outside the submitted work. The authors report no other potential conflicts of interest for this work.

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References

    1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–1487. doi:10.1016/j.resuscitation.2010.08.006 - DOI - PubMed
    1. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: a review. JAMA. 2019;321(12):1200–1210. doi:10.1001/jama.2019.1696 - DOI - PMC - PubMed
    1. Comess KA, Derook FA, Russell ML, Tognazzi-evans TA, Beach KW. The incidence of pulmonary embolism in pulseless electrical activity. Am J Med 1998;9343(June):351–356. - PubMed
    1. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30:1165–1171. doi:10.1016/S0735-1097(97)00319-7 - DOI - PubMed
    1. Bougouin W, Marijon E, Planquette B, et al. Pulmonary embolism related sudden cardiac arrest admitted alive at hospital: management and outcomes. Resuscitation. 2017;115:135–140. doi:10.1016/j.resuscitation.2017.04.019 - DOI - PubMed

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