title: Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the "PEAPETT" study).
abstract: OBJECTIVE
  Pulseless electrical activity (PEA) during cardiac arrest portends a poor prognosis. There is a paucity of data in the use of thrombolytic therapy in PEA and cardiopulmonary arrest due to confirmed pulmonary embolism (PE). We evaluated the outcome of low-dose systemic thrombolysis with tissue plasminogen activator (tPA) in patients presenting with PEA due to PE.
  
  
  METHODS
  During a 34-month period, we treated 23 patients with PEA and cardiopulmonary arrest due to confirmed massive PE. All patients received 50 mg of tPA as intravenous push in 1 minute while cardiopulmonary resuscitation was ongoing. The time from initiation of cardiopulmonary resuscitation to administration of tPA was 6.5 ± 2.1 minutes.
  
  
  RESULTS
  Return of spontaneous circulation occurred in 2 to 15 minutes after tPA administration in all but 1 patient. There was no minor or major bleeding despite chest compression. Of the 23 patients, 2 died in the hospital, and at 22 ± 3 months of follow-up, 20 patients (87%) were still alive. The right ventricular/left ventricular ratio and pulmonary artery systolic pressure dropped from 1.79 ± 0.27 and 58.10 ± 7.99 mm Hg on admission to 1.16 ± 0.13 and 40.25 ± 4.33 mm Hg within 48 hours, respectively (P< .001 for both comparisons). There was no recurrent venous thromboembolism or bleeding during hospitalization or at follow-up.
  
  
  CONCLUSIONS
  Rapid administration of 50 mg of tPA is safe and effective in restoration of spontaneous circulation in PEA due to massive PE leading to enhanced survival and significant reduction in pulmonary artery pressures.
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ; A.T. Still University, Mesa, AZ. Electronic address: seyedmohsensharifi@yahoo.com.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sharifi
authors.affiliation: A.T. Still University, Mesa, AZ.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Berger
authors.affiliation: Team Health West, Mesa, AZ.
authors.forename: Paul
authors.initials: P
authors.lastname: Beeston
authors.affiliation: A.T. Still University, Mesa, AZ.
authors.forename: Curt
authors.initials: C
authors.lastname: Bay
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Vajo
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ.
authors.forename: Seyed
authors.initials: S
authors.lastname: Javadpoor
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator