Thrombolysis During CPR Increases Survival in Pulmonary Embolism-Related Cardiac Arrest

Patients who had out-of-hospital cardiac arrest (OHCA) with confirmed pulmonary embolism (PE) and received thrombolysis during cardiopulmonary resuscitation (CPR) had significantly higher 30-day survival rates compared with patients who did not receive thrombolysis, according to retrospective observational multicenter study results published in CHEST.

PE-related OHCA is rare, occurring in 2% to 5% of all cases of OHCA, and is associated with a poor prognosis. Fortunately, thrombolysis can reduce mortality, decrease the risk of developing chronic thromboembolic pulmonary hypertension, and improve quality of life in patients with massive PE. However, whether or not thrombolysis during resuscitation can favor the return of spontaneous circulation and improve survival in patients with PE-related OHCA is unclear.

Therefore, researchers in France analyzed 246 adults with OHCA who were managed by a mobile intensive care unit and received a diagnosis of PE that was confirmed on hospital admission. Of these patients, 58 received thrombolysis during CPR, 43 received tenecteplase (74%), 14 received alteplase (24%), and 1 received streptokinase (2%). The researchers found that 30-day survival was higher in the thrombolysis group than the control group (16% vs 6%; P =.005), but that good neurologic outcome was not significantly different (10% vs 5%; adjusted relative risk, 1.97; 95% CI, 0.70-5.56). Length of stay in the intensive care unit ranged from 0 to 5 days in the thrombolysis group and 0 to 3 days in the control group (P =.23).

“We found that thrombolysis during [CPR] was associated with higher 30-day survival in PE-related OHCA,” the researchers concluded. However, a large randomized controlled trial is needed to confirm these results.

Reference

Javaudin F, Lascarrou JB, Le Bastard Q, et al. 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 online August 2, 2019]. CHEST. doi:10.1016/j.chest.2019.07.015