Impact of rescue-thrombolysis during cardiopulmonary resuscitation in patients with pulmonary embolism.
BACKGROUND
Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE.


RESULTS
We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.6+/-1.2 min versus 24.6+/-0.8 min; p<0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.0+/-1.3 vs. 22.5+/-0.9 min; p<0.001).


CONCLUSIONS
Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.
Er
Fikret
F
Department of Internal Medicine III, University of Cologne, Cologne, Germany. Fikret.Er@uk-koeln.de
Nia
Amir M
AM
Gassanov
Natig
N
Caglayan
Evren
E
Erdmann
Erland
E
Hoppe
Uta C
UC
D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000191:economics; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator