Cardiac Arrest Due to Fatal Pulmonary Thromboembolism: Two Cases Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 XuXiaomao ¹ , YeXiaohua ² , QiaoLisong ¹ , FangBaomin ¹ , SunTieying ¹

1. Department of Respiratory and Critial Care Medicine, Beijing Hospital, Beijing, 100730, China;
2. ;

Corresponding author：

XuXiaomao, Email: xuxiaomao@163.com

Keywords：

Fatal pulmonary embolism; Cardiac arrest; Thrombolysis; Return of spontaneous circulation

DOI：

10.7507/1671-6205.2016039

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Objective To describe the clinical profiles of cardiac arrest due to fatal pulmonary embolism (FPE), and review the literature on FPE diagnosis and treatment. Methods The clinical profiles of two cases with cardiac arrest for FPE were presented. A systematic search of Medline (1950 - 2014) and EMbase (1980-2014) was conducted to identify studies that investigated the use of thrombolytic medications to treat cardiac arrest for FPE. Results The fatal event of two patients occurred after surgery. Both of them survived with cardiopulmonary resuscitation and administration of thrombolysis and anticoagulation, but one of them had major bleeding during anticoagulation. Six articles were found involving 72473 cases of cardiac arrest due to pulmonary embolism (PE) or unstable massive PE. The thrombolytic agents were recombinant tissue plasminogen activator or streptokinase, but the administration and dose of thrombolytic agents were unclear. Overall, administration of thrombolytics can shorten the time to return of spontaneous circulation and improve the survival rate. There was, however, an increased risk of bleeding events following administration of thrombolytics. Conclusions Because of the high mortality of cardiac arrest for FPE, the clinician should correctly identify patients with a high likelihood of FPE. Early use of thrombolytics is very important and can potentially improve patient outcomes.

Citation： XuXiaomao, YeXiaohua, QiaoLisong, FangBaomin, SunTieying. Cardiac Arrest Due to Fatal Pulmonary Thromboembolism: Two Cases Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(2): 166-170. doi: 10.7507/1671-6205.2016039 Copy

1.	Hess EP, Campbell RL, White RD. Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation, 2007, 72: 200-206.
2.	Kuisma M, Alaspaa A. Out-of-hospital cardiac arrests of non-cardiac origin. Eur Heart J, 1997, 18: 1122-1128.
3.	Deasy C, Bray JE, Smith K, et al. Out-of-hospital cardiac arrest in young adults in Melbourne, Australia-adding coronial data to cardiac arrest registry. Resuscitation, 2011, 82: 1302-1306.
4.	Er F, Nia AM, Gassanov N, et al. Impact of rescue-thrombolysis during cardiopulmonary resuscitation in patients with pulmonary embolism. PLoS One, 2009, 4: e8323-e8328.
5.	Janata K, Holzer M, Kürkciyan I, et al. Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism. Resuscitation, 2003, 57: 49-55.
6.	Jerjes-Sanchez C, Ramirez-Rivera A, de Lourdes García M, et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis, 1995, 2: 227-229.
7.	Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as cause of cardiac arrest: presentation and outcome. Arch Intern Med, 2000, 160: 1529-1535.
8.	Le Conte P, Huchet L, Trewick D, et al. Efficacy of alteplase thrombolysis for ED treatment of pulmonary embolism with shock. Am J Emerg Med, 2003, 21: 438-440.
9.	Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med, 2012, 125: 465-470.
10.	Laporte S, Mismetti P, Décousus H, et al. Clinical predictors for fatal pulmonary embolism in 15520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermed and TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, 117: 1711-1716.
11.	Pineda LA, Hathwar VS, Grant BJ. Clinical suspicion of fatal pulmonary embolism. Chest, 2001, 120: 791-795.
12.	Kotovicz F, Mauad T, Saldiva PH. Clinico-pathological discrepancies in a general university hospital in Sao Paulo, Brazil. Clinics (Sao Paulo), 2008, 63: 581-588.
13.	Sweet PH Ⅲ, Armstrong T, Chen J, et al. Fatal pulmonary embolism update: 10 years of autopsy experience at an academic medical center. J R Soc Med Sh Rep, 2013, 4: 1-5.
14.	Mesquita CT, MorandiJúnior JL, Perrone FT, et al. Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation. Arq Bras Cardiol, 1999, 73: 255-258.
15.	Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ, 1991, 302: 709-711.
16.	Kasper W, Konstantinides S, Bergqvist D. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol, 1997, 30: 1165-1171.
17.	Goldhaber SZ, Visani L De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry(ICOPER). Lancet, 1999, 353: 1386-1389.
18.	CarvalhoBricola SA, Paiva EF, Lichtenstein A. Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study. Clinics (Sao Paulo), 2013, 68: 679-685.
19.	Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications. Am Heart J, 1995, 130: 1276-1282.
20.	Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest, 1997, 111: 209-217.
21.	Jardin F, Lacombe P, Dubourg O, et al. Quantitative two-dimensional echocardiography in acute pulmonary embolism. Presse Med, 1991, 20: 2085-2089.
22.	Courtney DM, Sasser HC, Pincus CL, et al. Pulseless electrical activity with witnessed arrest as a predictor of sudden death from massive pulmonary embolism in outpatients. Resuscitation, 2001, 49: 265-272.
23.	Courtney DM, Kline JA. Prospective use of a clinical decision rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. Resuscitation, 2005, 65: 57-64.
24.	Courtney DM, Kline JA, Kabrhel C, et al. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med, 2010, 55: 307-315.
25.	Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med, 2002, 136: 691-700.
26.	Comess KA, DeRook FA, Russell ML, et al. The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity. Am J Med, 2000, 109: 351-356.
27.	Torbicki A, Charbonnier B. Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J, 2000, 21: 1301-1336.
28.	Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29: 2276-2315.
29.	Goran KP. Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism. Eur Heart J, 2008, 29: 3066-3067.
30.	Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest: case report and systematic review of controlled trials. Ann Pharmacother, 2010, 44: 2007-2013.
31.	Morrison LJ, Deakin CD, Morley PT, et al. Part 8: advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation, 2010, 122: S345-421.
32.	Bottiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med, 2008, 359: 2651-2662.
33.	Deakin CD, Nolan JP, Soar J, et al. European resuscitation council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation, 2010, 81: 1305-1352.
34.	Logan JK, Pantle H, Huiras P, et al. Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism. Am J Emerg Med, 2014, 32: 789-796.
35.	Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35: 3033-3069.
36.	Wang C, Zhai Z, Yang Y, et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest, 2010, 137: 254-262.

1. Hess EP, Campbell RL, White RD. Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation, 2007, 72: 200-206.
2. Kuisma M, Alaspaa A. Out-of-hospital cardiac arrests of non-cardiac origin. Eur Heart J, 1997, 18: 1122-1128.
3. Deasy C, Bray JE, Smith K, et al. Out-of-hospital cardiac arrest in young adults in Melbourne, Australia-adding coronial data to cardiac arrest registry. Resuscitation, 2011, 82: 1302-1306.
4. Er F, Nia AM, Gassanov N, et al. Impact of rescue-thrombolysis during cardiopulmonary resuscitation in patients with pulmonary embolism. PLoS One, 2009, 4: e8323-e8328.
5. Janata K, Holzer M, Kürkciyan I, et al. Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism. Resuscitation, 2003, 57: 49-55.
6. Jerjes-Sanchez C, Ramirez-Rivera A, de Lourdes García M, et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis, 1995, 2: 227-229.
7. Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as cause of cardiac arrest: presentation and outcome. Arch Intern Med, 2000, 160: 1529-1535.
8. Le Conte P, Huchet L, Trewick D, et al. Efficacy of alteplase thrombolysis for ED treatment of pulmonary embolism with shock. Am J Emerg Med, 2003, 21: 438-440.
9. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med, 2012, 125: 465-470.
10. Laporte S, Mismetti P, Décousus H, et al. Clinical predictors for fatal pulmonary embolism in 15520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermed and TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, 117: 1711-1716.
11. Pineda LA, Hathwar VS, Grant BJ. Clinical suspicion of fatal pulmonary embolism. Chest, 2001, 120: 791-795.
12. Kotovicz F, Mauad T, Saldiva PH. Clinico-pathological discrepancies in a general university hospital in Sao Paulo, Brazil. Clinics (Sao Paulo), 2008, 63: 581-588.
13. Sweet PH Ⅲ, Armstrong T, Chen J, et al. Fatal pulmonary embolism update: 10 years of autopsy experience at an academic medical center. J R Soc Med Sh Rep, 2013, 4: 1-5.
14. Mesquita CT, MorandiJúnior JL, Perrone FT, et al. Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation. Arq Bras Cardiol, 1999, 73: 255-258.
15. Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ, 1991, 302: 709-711.
16. Kasper W, Konstantinides S, Bergqvist D. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol, 1997, 30: 1165-1171.
17. Goldhaber SZ, Visani L De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry(ICOPER). Lancet, 1999, 353: 1386-1389.
18. CarvalhoBricola SA, Paiva EF, Lichtenstein A. Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study. Clinics (Sao Paulo), 2013, 68: 679-685.
19. Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications. Am Heart J, 1995, 130: 1276-1282.
20. Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest, 1997, 111: 209-217.
21. Jardin F, Lacombe P, Dubourg O, et al. Quantitative two-dimensional echocardiography in acute pulmonary embolism. Presse Med, 1991, 20: 2085-2089.
22. Courtney DM, Sasser HC, Pincus CL, et al. Pulseless electrical activity with witnessed arrest as a predictor of sudden death from massive pulmonary embolism in outpatients. Resuscitation, 2001, 49: 265-272.
23. Courtney DM, Kline JA. Prospective use of a clinical decision rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. Resuscitation, 2005, 65: 57-64.
24. Courtney DM, Kline JA, Kabrhel C, et al. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med, 2010, 55: 307-315.
25. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med, 2002, 136: 691-700.
26. Comess KA, DeRook FA, Russell ML, et al. The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity. Am J Med, 2000, 109: 351-356.
27. Torbicki A, Charbonnier B. Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J, 2000, 21: 1301-1336.
28. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29: 2276-2315.
29. Goran KP. Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism. Eur Heart J, 2008, 29: 3066-3067.
30. Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest: case report and systematic review of controlled trials. Ann Pharmacother, 2010, 44: 2007-2013.
31. Morrison LJ, Deakin CD, Morley PT, et al. Part 8: advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation, 2010, 122: S345-421.
32. Bottiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med, 2008, 359: 2651-2662.
33. Deakin CD, Nolan JP, Soar J, et al. European resuscitation council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation, 2010, 81: 1305-1352.
34. Logan JK, Pantle H, Huiras P, et al. Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism. Am J Emerg Med, 2014, 32: 789-796.
35. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35: 3033-3069.
36. Wang C, Zhai Z, Yang Y, et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest, 2010, 137: 254-262.

Chinese Journal of Respiratory and Critical Care Medicine

Cardiac Arrest Due to Fatal Pulmonary Thromboembolism: Two Cases Report and Literature Review

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