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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 02, 2019
Footnotes
FUNDING/SUPPORT: The French National Out-of-Hospital Cardiac Arrest Registry (RéAC) is supported by the French Society of Emergency Medicine (SFMU), a patient foundation, the Fédération Française de Cardiologie , the Mutuelle Générale de l'Education Nationale (MGEN), the University of Lille , and the Institute of Health Engineering of Lille .
Identification
Copyright
© 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- ResponseCHESTVol. 157Issue 5
- Confirm, Don’t Conform Toward Thrombolysis in Acute Pulmonary Embolism in Out-of-Hospital Cardiac ArrestCHESTVol. 157Issue 5
- In BriefIn 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.
- Full-Text
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