Evaluation of Rescue Thrombolysis in Cardiac Arrest Secondary to Suspected or Confirmed Pulmonary Embolism

Abstract

Background: Pulmonary embolism (PE) is the associated cause of unexplained cardiac arrest in 5% to 13% of patients. Although thrombolytic agents have been studied, patient outcomes during cardiac arrest are lacking. Objective: The purpose of this study was to describe outcomes of patients who received thrombolytic therapy during cardiac arrest for suspected or confirmed PE. Methods: This retrospective review included adults who received alteplase or tenecteplase during cardiac arrest for suspected or confirmed PE. The primary end point was incidence of survival to hospital discharge, whereas secondary end points included a description of dosing strategies of thrombolytic therapy, the incidence of return of spontaneous circulation (ROSC), the occurrence of minor or major bleeding, and intensive care unit and hospital lengths of stay. Results: Of the 22 patients included in the study, 3 patients (13.6%) survived to hospital discharge, and ROSC was obtained in 11 patients (50%). Three patients had confirmed PE prior to cardiac arrest, with the remaining 19 patients having a documented suspicion for PE. The most frequent dosing strategy was alteplase 100 mg given via intravenous push (13 of 22 patients; 59%). One minor and no major bleeding events occurred. Conclusion and Relevance: Medical advances in PE management continue to evolve; yet the role of thrombolytic therapy in PE-related cardiac arrest remains unclear, with low overall rates of survival. These findings add to the relatively small body of evidence and highlight that optimal dosing remains unknown in this setting.

In-hospital cardiac arrest due to pulmonary embolism – Treatment and outcomes in a Swedish cohort study

“…Our cohort had similar short times to ROSC It is also possible that non-documented contraindications were present in patients with suspected PE not receiving thrombolysis. Nevertheless, our results are consistent with the findings of Summers et al, 8 who reported no events of major bleeding in 22 patients with PE-related IHCA who had been administered thrombolysis. It should further be noted that cases of minor bleeding in our study were seemingly unrelated to CPR, and not more common in patients where thrombolysis was initiated during CPR than in those where it was initiated before or after.…”

“…Few studies have assessed treatment for PE given intra-arrest, but some observational studies on out-of-hospital cardiac arrest (OHCA) and PE have shown no difference 7. , 8. or increased survival among those receiving thrombolysis.…”

Erweiterte lebensrettende Maßnahmen für Erwachsene

“…Der ERC empfiehlt den routinemäßigen Einsatz von Thrombolytika bei Kreislaufstillstand nicht, es sei denn bei vermuteter oder bestätigter LE. Wenn Thrombolytika verabreicht wurden, sollen die Wiederbelebungsmaßnahmen mindestens 60 bis 90 min lang vor Abbruch fortgeführt werden [ 330 – 332 ].…”

Kreislaufstillstand unter besonderen Umständen

“…Es gibt keine ausreichenden Nachweise, um eine Empfehlung bezüglich eines optimalen Medikaments oder einer Dosierungsstrategie zur Thrombolyse während der Wiederbelebung geben zu können [ 2 ]. Wenn Thrombolytika verabreicht wurden, sollen Sie erwägen, die Wiederbelebungsversuche für mindestens 60–90 min fortzusetzen, bevor Sie die Wiederbelebungsversuche einstellen [ 230 – 232 ].…”