Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival

Findings From the French National Cardiac Arrest Registry
Published:August 02, 2019DOI:https://doi.org/10.1016/j.chest.2019.07.015

      Background

      Pulmonary embolism (PE) represents 2% to 5% of all causes of out-of-hospital cardiac arrest (OHCA) and is associated with extremely unfavorable prognosis. In PE-related OHCA, inconsistent data showed that thrombolysis during cardiopulmonary resuscitation may favor survival.

      Methods

      This was a retrospective, observational, multicenter study from July 2011 to March 2018. All adults with OHCA, treated by a mobile ICU and with a diagnosis of PE confirmed on hospital admission, were included. The primary end point was 30-day survival in a weighted population.

      Results

      Of the 14,253 patients admitted to hospitals, 328 had a final diagnosis of PE and 246 were included in the analysis. In the group that received thrombolysis during resuscitation (n = 58), 14 (24%) received alteplase, 43 (74%) received tenecteplase, and one (2%) received streptokinase. Thirty-day survival was higher in the thrombolysis group than in the control group (16% vs 6%; P = .005; adjusted log-rank test) but the good neurologic outcome was not significantly different (10% vs 5%; adjusted relative risk, 1.97; 95% CI, 0.70-5.56). Median duration of stay in the ICU was 1 (0-5) day for the thrombolysis group and 1 (0-3) day for the control group ( P = .23).

      Conclusions

      In patients with OHCA with confirmed PE and admitted with recuperation of spontaneous circulation in the hospital, there was significantly higher 30-day survival in those who received thrombolysis during cardiopulmonary resuscitation compared with patients who did not receive thrombolysis.

      Key Words

      Abbreviations:

      BLS ( basic life support), CPC ( Glasgow-Pittsburgh Cerebral Performance Category), CPR ( cardiopulmonary resuscitation), CTPA ( CT pulmonary angiography), IPTW ( inverse probability of treatment weighting), MICU ( mobile ICU), OHCA ( out-of-hospital cardiac arrest), PE ( pulmonary embolism), RéAC ( French National OHCA Registry), ROSC ( return of spontaneous circulation)
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      Linked Article

      • Response
        CHESTVol. 157Issue 5
        • In Brief
          We thank Drs Patel and Bergl for their interest and comments regarding our article on thrombolysis during resuscitation of out-of-hospital cardiac arrest (OHCA) caused by pulmonary embolism (PE).1 They highlight some limitations of our study that we will clarify point by point.
        • Full-Text
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      • Confirm, Don’t Conform Toward Thrombolysis in Acute Pulmonary Embolism in Out-of-Hospital Cardiac Arrest
        CHESTVol. 157Issue 5
        • In Brief
          In a recent issue of CHEST (December 2019), using the French National Cardiac Arrest Registry to identify pulmonary embolism (PE)-related out-of-hospital cardiac arrests (OHCAs), Javaudin et al1 found higher 30-day suval in those who received thrombolysis during CPR compared with patients who did not receive thrombolysis, after weighting the population using seven variables.1 Although the authors’ conclusions may stoke our collective curiosity, we would like to explore methodologic concerns that may limit their soundness.
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