Cardiac Arrest Survivors with Acute PE – Characteristics and Outcomes

Written by Bo Stubblefield

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Survivors of cardiac arrest (alive ≥ 24h post CPR) found to have pulmonary embolism (PE) did not demonstrate a significant difference in mortality compared to those without PE. There was no difference in mortality between PE patients who received thrombolytics and those who did not.

Why does this matter?
The majority of patients with acute PE are hemodynamically stable and have low 30-day mortality rates (1,2). Yet, the mortality of PE associated with circulatory shock (SBP <90 mmHg) remains high (2,3). and is estimated to be responsible for 6-13% of out-of-hospital and in-hospital cardiac arrest (4-7). Acute PE in this cardiac arrest population is not well studied. The authors sought to compare the characteristics and outcomes of this cohort within this critically ill population. 

Post-arrest PE: What does that even look like, man?
This was a single site, retrospective cohort study which included consecutive adult patients with cardiac arrest and CPR with survival ≥ 24h post ROSC. Authors included 996 patients with both in-hospital (n=322) and out-of-hospital (n=674) cardiac arrest. Acute PE was diagnosed in 8.7% of patients based on history, clinical findings, and confirmed by computed tomography angiography (CTA). Unsurprisingly, the majority of those with PE had echo findings consistent with RV dysfunction, strain, or dilation. Predictors of mortality were age, female sex, diabetes, ESRD, and (interestingly) the use of targeted temperature management. As a primary outcome, the diagnosis of PE was not associated with increased mortality when compared to non-PE cardiac arrest patients. Further, there was no difference in mortality between PE patients who received thrombolytics and those who did not. Although limited by its retrospective design in addition to survival and selection biases, this study helps to better characterize a subgroup of sick patients with acute PE. 

Source
Characteristics and outcomes of cardiac arrest survivors with acute pulmonary embolism. Resuscitation. 2020 Oct;155:6-12. doi: 10.1016/j.resuscitation.2020.06.029.  

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Reviewed by Clay Smith

Works Cited

  1. Jimenez D, Bikdeli B, Barrios D, et al. Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism. Int J Cardiol 2018;269:327-33.

  2. Lin BW, Schreiber DH, Liu G, et al. Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry. Am J Emerg Med 2012;30:1774-81.

  3. Stein PD, Matta F, Alrifai A, Rahman A. Trends in case fatality rate in pulmonary embolism according to stability and treatment. Thrombosis research 2012;130:841-6.

  4. Bergum D, Nordseth T, Mjolstad OC, Skogvoll E, Haugen BO. Causes of in-hospital cardiac arrest – incidences and rate of recognition. Resuscitation 2015;87:63-8.

  5. Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160:1529-35.

  6. Silfvast T. Cause of death in unsuccessful prehospital resuscitation. J Intern Med 1991;229:331-5.

  7. Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S501-18.

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