Retrospective review of thrombolytic use for cardiac arrest due to suspected pulmonary embolism

Abstract

Background

Massive pulmonary embolism (PE) causing obstructive shock can lead to circulatory failure and cardiac arrest. There is a paucity of data describing current practice around thrombolytic use and outcomes in this patient population.

Objective

The objective of this study was to describe the characteristics and outcomes of patients who received a thrombolytic agent during cardiac arrest due to suspected PE, including efficacy and safety.

Methods

This study was a retrospective, descriptive cohort of 32 adult patients who received alteplase or tenecteplase in the emergency department during active cardiac arrest. Agent selection and dosing were at the discretion of the primary provider.

Results

Most patients presented with a witnessed out-of-hospital cardiac arrest with a non-shockable rhythm. The mean age was 63 years. Dyspnea was most commonly reported prior to cardiac arrest. The median dose for alteplase was 50 mg and for tenecteplase was 45 mg. Eleven patients achieved ROSC after thrombolytic administration; seven of these patients survived to hospital admission. All but one patient experienced a major bleeding event during admission. Ultimately, only two patients survived to hospital discharge. A subgroup analysis compared patients administered alteplase to those administered tenecteplase. Nine of the eleven patients that achieved ROSC were administered alteplase, five of which survived to hospital admission. All five patients experienced a major bleeding event. Two of the eleven patients that achieved ROSC were administered tenecteplase, both of which survived to hospital admission. One patient experienced a major bleeding event. Ultimately, only one patient in each group survived to hospital discharge.

Conclusion

This study provides new data regarding the outcomes of thrombolytic therapy in patients experiencing cardiac arrest due to suspected massive PE. Despite administration of thrombolytics, survival to hospital admission and subsequent survival to hospital discharge were seen in only a very small proportion of patients. Further research is necessary to optimize the management of this life-threatening condition.