scholarly journals Thrombolytic therapy during resuscitation for pulmonary embolism-related out-of-hospital cardiac arrest: perhaps not the ideal solution for everyone

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Patrick M. Honore ◽  
Cristina David ◽  
Aude Mugisha ◽  
Rachid Attou ◽  
Sebastien Redant ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Thrombolytic Therapy ◽  
Ideal Solution ◽  
Hospital Cardiac Arrest ◽  
The Ideal

scholarly journals Improving identification of pulmonary embolism-related out-of-hospital cardiac arrest to optimize thrombolytic therapy during resuscitation

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
François Javaudin ◽  
◽  
Jean-Baptiste Lascarrou ◽  
Hyacinthe Esquina ◽  
Valentine Baert ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Thrombolytic Therapy ◽  
Hospital Cardiac Arrest

Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shinichi Ijuin ◽  
Akihiko Inoue ◽  
Nobuaki Igarashi ◽  
Shigenari Matsuyama ◽  
Tetsunori Kawase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Accidental Hypothermia ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Group B ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

scholarly journals Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy

2020 ◽  
Vol 13 (4) ◽  
pp. e234083 ◽  
Author(s):  
John Edward Ashbridge Taylor ◽  
Chen Wen Ngua ◽  
Matthew Carwardine
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Postmortem Examination ◽  
Right Heart ◽  
Hypoxic Injury ◽  
Injury Treatment ◽  
Ct Brain ◽  
Hospital Cardiac Arrest

Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.

scholarly journals Pediatric In-Hospital Cardiac Arrest Secondary to Acute Pulmonary Embolism

2018 ◽  
Vol 46 (3) ◽  
pp. e229-e234 ◽  
Author(s):  
Ryan W. Morgan ◽  
Hannah R. Stinson ◽  
Heather Wolfe ◽  
Robert B. Lindell ◽  
Alexis A. Topjian ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Acute Pulmonary Embolism ◽  
Hospital Cardiac Arrest

Thrombolytic therapy during prolonged in-hospital cardiac arrest

2005 ◽  
Vol 12 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Gianfranco de Rose ◽  
Nicola Parenti ◽  
Angelo Fanciulli
Keyword(s):  
Cardiac Arrest ◽  
Thrombolytic Therapy ◽  
Hospital Cardiac Arrest

scholarly journals Return of spontaneous circulation in patients with out-of-hospital cardiac arrest caused by pulmonary embolism using early point-of-care ultrasound and timely thrombolytic agent application: Two case reports

2020 ◽  
pp. 102490792096413
Author(s):  
Su Yeong Pyo ◽  
Gwan Jin Park ◽  
Sang Chul Kim ◽  
Hoon Kim ◽  
Suk Woo Lee ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Acute Pulmonary Embolism ◽  
Thrombolytic Agent ◽  
Point Of Care ◽  
Fibrinolytic Therapy ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Hospital Cardiac Arrest

Introduction: Acute pulmonary embolism is a confirmed cause of up to 5% of out-of-hospital cardiac arrest and 5%–13% of unexplained cardiac arrest in patients. However, the true incidence may be much higher, as pulmonary embolism is often clinically underdiagnosed. Thrombolytic therapy is a recognized therapy for pulmonary embolism–associated cardiac arrest but is not routinely recommended during cardiopulmonary resuscitation. Therefore, clinicians should attempt to identify patients with suspected pulmonary embolism. Many point-of care ultrasound protocols suggest diagnosis of pulmonary embolism for cardiac arrest patients. Case presentation: We describe two male patients (60 years and 66 years, respectively) who presented to the emergency department with cardiac arrest within a period of 1 week. With administration of point-of care ultrasound during the ongoing cardiopulmonary resuscitation in both patients, fibrinolytic therapy was initiated under suspicion of cardiac arrest caused by pulmonary embolism. Both patients had return of spontaneous circulation; however, only the second patient, who received fibrinolytic therapy relatively early, was discharged with a good outcome. In this report, we discussed how to diagnose and manage patients with cardiac arrest–associated pulmonary embolism with the help of point-of care ultrasound. We also discuss the different clinical outcomes of the two patients based on the experience of the clinicians and the timing of thrombolytic agent application. Conclusions: If acute pulmonary embolism is suspected in patients with out-of-hospital cardiac arrest, we recommend prompt point-of care ultrasound examination. Point-of care ultrasound may help identify patients with pulmonary embolism during cardiopulmonary resuscitation, leading to immediate treatment, although the clinical outcomes may vary.

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