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

Abstract

David de Paz,1– 4 Julio Diez,1 Fredy Ariza,2 Diego Fernando Scarpetta,1– 5 Jaime A Quintero,1– 3 Sandra Milena Carvajal1 1Department of Emergency Service, Fundación Valle del Lili, Cali, 760032, Colombia; 2Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali 760032, Colombia; 3Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali 760032, Colombia; 4Internal Medicine Residency, Universidad CES, Medellín 050021, Colombia; 5Internal Medicine Residency, Universidad ICESI, Cali, ColombiaCorrespondence: Sandra Milena CarvajalDepartment Emergency Service, Fundación Valle del Lili Hospital, Carrera 98 No. 18-49, Cali, 760032, ColombiaEmail [email protected]: 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: pulmonary embolism, cardiac arrest, return of spontaneous circulation

Keywords

• pulmonary embolism
• cardiac arrest
• return of spontaneous circulation