Mortality of patients with pulmonary embolism.
BACKGROUND
Pulmonary embolism (PE) is a potentially fatal disorder with highly varying mortality rates. To provide information that is more precise for prospective intervention studies, we analysed the data of our patients with PE, defining clinically relevant subgroups with respect to their individual mortality rates.


METHODS
We studied 283 consecutive patients with confirmed PE diagnosis, with respect to demographic data, risk factors for thromboembolic disease and clinical signs. In addition, diagnostic and therapeutic interventions such as blood gas analysis (BGA), lactate and D-dimer determination, electrocardiography (ECG), echocardiography, spiral computer tomography (Spiral CT), ventilation/perfusion lung scintigraphy (V/Q-Scan), thrombolytic therapy, mechanical ventilation, and cardiopulmonary resuscitation (CPR), were accounted for. Study endpoint was mortality rates on day three.


RESULTS
Overall, mortality rate was 15% (42 of 283). Mortality rates differed considerably; 95% of patients with cardiac arrest on arrival (21 of 22), 85% of patients with cardiac arrest--not in hospital (28 of 33), 80% of patients receiving mechanical ventilation (40 of 50), 77% of patients needing cardiopulmonary resuscitation within the first 24 hours (37 of 48), 37% of patients with syncope (18 of 49), 30% of patients receiving thrombolytic treatment (25 of 87), 26% of patients on whom lactate measurement was performed (36 of 139), 18% of patients on whom blood gas analysis was done (35 of 197), 17% of patients on whom echocardiography was performed (34 of 195), 8% of patients with twelve complete lead ECG recordings (21 of 262) and D-Dimer determination (12 of 148), 2% of patients tested on Spiral CT (5 of 226) and 1% where a V/Q-Scan was performed (1 of 74).


CONCLUSIONS
Patients with PE who received mechanical ventilation, cardiopulmonary resuscitation, and thrombolytic treatment had very high mortality rates of 80, 77 and 30% respectively. However, patients stable enough for diagnostic procedures as Spiral CTs and V/Q-Scans had mortality rates of 1 to 2%. These facts are to be considered when planning pulmonary embolism intervention trials in which reduction of mortality is a defined endpoint.
Janata
Karin
K
Universitätsklinik für Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, Vienna, Austria. karin.janata@akh-wien.ac.at
Holzer
Michael
M
Domanovits
Hans
H
Müllner
Marcus
M
Bankier
Alexander
A
Kurtaran
Amir
A
Bankl
Hans C
HC
Laggner
Anton N
AN
D000328:Adult; D000368:Aged; D001317:Austria; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D002423:Cause of Death; D003952:Diagnostic Imaging; D005260:Female; D006323:Heart Arrest / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial / Q000401:mortality; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000401:mortality