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Chest. 2019 Dec;156(6):1167-1175. doi: 10.1016/j.chest.2019.07.015. Epub 2019 Aug 2.

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.

Author information

1
Department of Emergency Medicine, University Hospital of Nantes, France; Microbiotas, Hosts, Antibiotics, and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France. Electronic address: francois.javaudin@chu-nantes.fr.
2
Medical ICU, University Hospital of Nantes, Nantes, France.
3
Department of Emergency Medicine, University Hospital of Nantes, France; Microbiotas, Hosts, Antibiotics, and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France.
4
Department of Emergency Medicine, University Hospital of Nantes, France.
5
Public Health Department EA 2694, University of Lille, Lille University Hospital, Lille, France.
6
Microbiotas, Hosts, Antibiotics, and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France; Department of Epidemiology and Medical Evaluation, University Hospital of Nantes, Nantes, France.

Abstract

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.

KEYWORDS:

cardiopulmonary resuscitation; out-of-hospital cardiac arrest; pulmonary embolism; thrombolytic therapy

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