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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

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.
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https://hal.univ-lille.fr/hal-03243260
Contributeur : Lilloa Université de Lille <>
Soumis le : lundi 31 mai 2021 - 15:06:03
Dernière modification le : mardi 1 juin 2021 - 03:20:47

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François Javaudin, Jean-Baptiste Lascarrou, Quentin Le Bastard, Quentin Bourry, Chloe Latour, et al.. 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. Chest, 2019, Chest, 156 (6), pp.1167-1175. ⟨10.1016/j.chest.2019.07.015⟩. ⟨hal-03243260⟩

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