Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Cardiac Arrest Associated With PE

Question Type:
Intervention
Full Question:
Among adults who are in cardiac arrest due to PE or suspected PE in any setting  (P), does does any specific alteration in treatment algorithm (eg, fibrinolytics, or any other)  (I), compared with compared with standard care (according to 2010 treatment algorithm)  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC (O)?
Consensus on Science:

Fibrinolysis
For the critical outcome of survival with favorable neurologic status at 30, 90, or 180 days, there was very-low-quality evidence (downgraded for serious imprecision) from 1 RCT comparing fibrinolytics versus placebo during cardiac arrest.(Bottiger 2008, 2651) In this double-blinded RCT, 37 of the 1050 patients randomized to receive either fibrinolytic treatment (tenecteplase) or placebo during CPR had confirmed PE as primary cause of cardiac arrest. However, this study was not powered to reach significance in this small subgroup. Patients in whom PE was suspected were furthermore subject to use of open-label fibrinolysis and were not included in the trial at all. The 30-day survival in this subgroup was not statistically different (P=0.31; RR, 7.19; 95% CI, 0.37–139.9) between tenecteplase (2/15, 13.3%) and placebo (0/22, 0%). For the important outcome of survival to hospital discharge, very-low-quality evidence (downgraded for very serious risk of bias and imprecision) from 2 retrospective observational studies showed there was no difference in discharge rates: 9.5% fibrinolysis versus 4.8% control(Kurkciyan 2000, 1529) and 19.4% fibrinolysis versus 6.7% control (RR, 2.9; 95% CI, 0.75–13.8).(Janata 2003, 49) For the important outcome of ROSC, very-low-quality evidence from 2 studies (downgraded for very serious risk of bias) showed benefit for the use of fibrinolytic drugs compared with controls in patients with PE: ROSC was reported to be significantly higher in a retrospective analysis (81.0% fibrinolysis versus 42.9% control; P=0.03).(Kurkciyan 2000, 1529) In a separate study, ROSC (66.7% in fibrinolysis group versus 43.3% in control group; RR, 1.5; 95% CI, 0.8–8.6) was not different, but 24-hour survival (52.8% fibrinolysis versus 23.3% control; RR, 2.3; 95% CI, 1.1–4.7) showed favorable results for the use of fibrinolytic drugs.(Janata 2003, 49)
Surgical Embolectomy
We found very-low-quality evidence (downgraded for very serious risk of publication bias) from 2 case series(Doerge 1996, 952; Konstantinov 2007, 41) with no control groups and a total of 21 patients requiring CPR with a 30-day survival rate of 12.5% and 71.4%, respectively.
Percutaneous Mechanical Thrombectomy
For the important outcome of ROSC, very-low-quality evidence (downgraded for very serious risk of bias and very serious imprecision) from 1 case series of 7 patients with cardiac arrest with no control group,(Fava 2005, 119) ROSC was achieved in 6 of 7 patients (85.7%) treated with percutaneous mechanical thrombectomy.
Treatment Recommendation:
We suggest administering fibrinolytic drugs for cardiac arrest when PE is the suspected cause of cardiac arrest (weak recommendation, very-low-quality evidence). We suggest the use of fibrinolytic drugs or surgical embolectomy or percutaneous mechanical thrombectomy for cardiac arrest when PE is the known cause of cardiac arrest (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making these recommendations, we acknowledge the use of thrombolytic drugs, surgical embolectomy or percutaneous mechanical thrombectomy, or a combination for known PE in non–cardiac arrest patients. We acknowledge the potential risk of bleeding after fibrinolysis and place value in the choice of intervention taking into account location, availability of interventions, and contraindications to fibrinolysis.
CoSTR Attachments:
435 Percutaneous_2015_02_21.pdf    
435 Surgical Embolectomy_2015_02_21.pdf    
435 thrombolytic drug (NonRCT)_2015_02_21.pdf    
435 thrombolytic drug (RCT)_2015_02_21.pdf    

 Contact Us

 
If you have any comments or questions on this page, please email us at: