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.

Abstract

BACKGROUND\nPulmonary 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 (CPR) may favor survival.\n\n\nMETHODS\nIt was a retrospective, observational, multicenter study from July 2011 to March 2018. All adult OHCA, managed by a mobile intensive care unit, and with a diagnosis of pulmonary embolism confirmed on hospital admission were included. The primary end point was day-30 survival in a weighted population.\n\n\nRESULTS\nOf the 14,253 patients admitted to the 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 received alteplase (24%), 43 tenecteplase (74%) and 1 streptokinase (2%). Thirty-day survival was higher in the thrombolysis group than in the control group (16% vs 6%, P=0.005; adjusted log-rank test) but the good neurological outcome was no significantly different (10% vs 5%; adjusted relative risk = 1.97 CI95[0.70-5.56]). Median duration of stay in the intensive care unit (ICU) was 1 (0-5) day in the thrombolysis group and 1 (0-3) day in the control group (P=0.23).\n\n\nCONCLUSIONS\nIn OHCA patients 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 CPR compared with patients who did not receive thrombolysis.