Elsevier

Resuscitation

Volume 155, October 2020, Pages 6-12
Resuscitation

Clinical paper
Characteristics and outcomes of cardiac arrest survivors with acute pulmonary embolism

https://doi.org/10.1016/j.resuscitation.2020.06.029Get rights and content

Abstract

Introduction

The characteristics and outcomes of patients that suffer cardiac arrest due to acute pulmonary embolism (PE) are not well studied. We compared the characteristics and outcomes of cardiac arrest survivors that suffered PE with other forms of cardiac arrest.

Methods

Consecutive cardiac arrest survivors were enrolled that were able to survive for 24 h post cardiopulmonary resuscitation. Diagnosis of PE was confirmed by CT angiogram or high-probability of PE on ventilation perfusion scan after the successful resuscitation from cardiac arrest. Survival curves were examined and predictors of mortality in PE patients were examined in an adjusted Cox proportional hazard model.

Results

Among the 996 cardiac arrest patients (mean age 62.6 ± 14.8 years, females 39.4%), 87 (8.7%) patients were found to have acute PE. The mortality rate of cardiac arrest survivors with and without acute PE was not significant different (68.3% vs. 64%). There were no significant differences in mortality among PE patients that received thrombolytics versus those who did not. Out of 87 patients, 33 (37.9%) required transfusion and had a bleeding complication. The risk of mortality in PE patients was predicted by older age, female sex, history of diabetes mellitus, end-stage renal disease and use of targeted temperature management.

Conclusion

Cardiac arrest survivors with PE did not have significantly better survival than patients with non-PE related cardiac arrest. In addition, use of thrombolytics did not improve survival but these patients ended up requiring transfusion that could have off set the benefit of thrombolytics.

Introduction

Acute pulmonary embolism (PE), one of the manifestations of venous thromboembolic disease affects an estimated 300,000–600,000 individuals in United States each year, causing around 100,000 deaths.1, 2, 3 It is estimated that around 5% of these PE cases may progress to cardiac arrest with a mortality rate of up to 90%.4, 5 PE is responsible for 10–13% of outside hospital cardiac arrest (OHCA) and 6% of in-hospital cardiac arrest (IHCA).6, 7, 8, 9 Studies have suggested that the occurrences of cardiac arrest could be even higher as many cases are detected only at the time of autopsy after death.10 The American Heart Association/American College of Cardiology resuscitation guidelines make no distinction in resuscitation procedures for a patient with suspected PE. However, the European Society of Cardiology guidelines recommends a longer 60–90 min cardiopulmonary resuscitation (CPR) in patients who receive intravenous thrombolytic compared to the normal resuscitation protocol.9, 11, 12 However, the relative outcomes of patients with cardiac arrest secondary to PE in comparison to other causes of cardiac arrest are still unknown. Describing the characteristics of these patients and their outcomes could provide us with an insight into epidemiology and natural history of this subset of cardiac arrest patients. Therefore, we described the clinical characteristics of cardiac arrest survivors with PE and their outcomes in comparison with non-PE cardiac arrest patients.

Section snippets

Patient population and settings

This is a retrospective cohort study conducted at a large tertiary care hospital with a large catchment area covering western North Carolina. We performed a chart review of 4047 consecutive patients that had a diagnosis of cardiac arrest at Wake Forest Baptist Hospital over a period of 6 years (January 1, 2012–December 31, 2017). We included all adult consecutive patients with out of hospital and in hospital cardiac arrest that survived after a successful CPR beyond 24 h or more. Cardiac arrest

Baseline characteristics

Among 996 successfully resuscitated cardiac arrest patients included in the study, 87 (8.7%) patients were diagnosed with acute central PE. The baseline characteristics of the patients are given in Table 1. Both study groups were of similar age (acute PE 63.8 ± 14.2 years vs.no PE 62.4 ± 14.8 years) and had similar distribution of men (acute PE 66% vs. no PE 60%). The prevalence of smokers and in-hospital cardiac arrest were higher while the use of targeted temperature management was lower in

Discussion

To the best of our knowledge, this is the first study that has evaluated the survival in cardiac arrest PE survivors and compared with those without PE. We observed that the mortality of cardiac arrest survivors with and without PE was not significantly different. We also did not observe a significant impact of thrombolytics on mortality in this group. There were several predictors of mortality in PE patients including age, female sex, diabetes, end-stage renal disease and use of targeted

Conclusions

In conclusion, the study demonstrated that patients with cardiac arrest and PE had a similar survival outcome as those without PE. The use of thrombolytic did not have survival benefit in patients with cardiac arrest survivors with acute PE. The study also highlights the importance of early diagnosis and prevention of acute PE as the outcomes are poor after cardiac arrest even in best institutions with mechanical circulatory devices.

Conflicts of interest

The authors declare that they have no conflict of interest.

CRediT authorship contribution statement

Bhupendar Tayal: Methodology. Kristian Hay Kragholm: Validation. Youssef Masmoudi: Data curation. John Azizian: Data curation. Lawson Mcdonald: Data curation. Amandeep Goyal: Writing - review & editing. Peter Sogaard: Conceptualization. Waqas T. Qureshi: Formal analysis.

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