title: Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism.
abstract: BACKGROUND
  Tissue plasminogen activator (tPA) is used emergently to dissolve thrombi in the treatment of fulminant pulmonary embolism. Currently, there is a relative contraindication to tPA in the setting of traumatic or prolonged cardiopulmonary resuscitation > 10 minutes because of the risk of massive hemorrhage.
  
  
  METHODS
  Our single-center, retrospective study investigated patients experiencing cardiac arrest (CA) secondary to pulmonary embolus. We compared the effectiveness of advanced cardiac life support with the administration of tPA vs. the standard of care consisting of advanced cardiac life support without thrombolysis. The primary endpoint was survival to discharge. Secondary endpoints were return of spontaneous circulation (ROSC), major bleeding, and minor bleeding.
  
  
  RESULTS
  We analyzed 42 patients, of whom 19 received tPA during CA. Patients who received tPA were not associated with a statistically significant increase in survival to discharge (10.5% vs. 8.7%, P = 1.00) or ROSC (47.4% vs. 47.8%, P = 0.98) compared to the control group. We observed no statistically significant difference between the groups in major bleeding events (5.3% in the tPA group vs. 4.3% in the control group, P = 1.00) and minor bleeding events (10.5% in the tPA group vs. 0.0% in the control group, P = 0.11).
  
  
  CONCLUSIONS
  This study did not find a statistically significant difference in survival to discharge or in ROSC in patients treated with tPA during CA compared to patients treated with standard therapy. However, because no significant difference was found in major or minor bleeding, we suggest that the potential therapeutic benefits of this medication should not be limited by the potential for massive hemorrhage. Larger prospective studies are warranted to define the efficacy and safety profile of thrombolytic use in this population.
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Tariq
authors: T
authors: Yousuf
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Taylor
authors: T
authors: Brinton
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Khansa
authors: K
authors: Ahmed
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Joy
authors: J
authors: Iskander
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Daniel
authors: D
authors: Woznicka
authors: Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
authors: Jason
authors: J
authors: Kramer
authors: Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
authors: Adam
authors: A
authors: Kopiec
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Amar R
authors: AR
authors: Chadaga
authors: Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors: Kathia
authors: K
authors: Ortiz
keywords: Cardiopulmonary resuscitation; Heart arrest; Pulmonary embolism; Thrombolytic therapy; Tissue plasminogen activator