SESSION TITLE: Critical Care - It's Not Just the Lungs
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Tissue Plasminogen Activator (tPA) is seen as the quickest and most effective way to dissolve a thrombus. It dissolves existing clots in the bloodstream, whereas antithrombotic medications prevent new clots from forming. TPA’s only current indication is in treatment of hemodynamically unstable pulmonary embolus (PE). Currently, tPA is not routinely given in patients suffering concurrent cardiac arrest due to the risk of massive hemorrhage and few have investigated this [1,2]. We are comparing tPA administration to fibrinolytic therapy in patients suffering from cardiac arrest due to PE.
METHODS: This is a single center, retrospective study on patients with the diagnosis of PE who subsequently suffered a cardiac arrest. We compared the administration of tPA versus no fibrinolytic therapy in this patient population, with the primary endpoint of survival to discharge. Secondary endpoints include return of spontaneous circulation, major and minor bleeding.
RESULTS: We analyzed 42 patients, 19 of which received tPA during a cardiac arrest, 23 did not. Patients receiving tPA were not associated with a statistically significant increased return of spontaneous circulation (47.4% vs 47.8%) or survival upon discharge (10.5% vs 8.7%). However, there was also no statistically significant difference seen in the major bleeding events between the groups (4.3 % vs 5.3 %).
CONCLUSIONS: This study did not find statistically significant difference in outcomes in those treated with tPA during cardiac arrest but there was also no difference in major or minor bleeding. Therefore, the potential therapeutic benefits of this medication should not be limited by reservations of massive hemorrhage.
CLINICAL IMPLICATIONS: The goal of our study was to assess the response of a patient experiencing cardiac arrest, secondary to a pulmonary embolus, to tPA versus standard fibrinolytic therapy. As shown in our results section, ROSC and survival upon discharge may not be improved with the administration of tPA but the risk of major life-threatening bleeds is also not substantially increased. Therefore, a clinician may decide to administer tPA in a last ditch effort but realize that this will not lead to a major bleeding event.
DISCLOSURE: The following authors have nothing to disclose: Tariq Yousuf, Taylor Brinton, Jason Kramer, Jeffrey Ziffra, Dana Villines, Anup Kumar, Kathia Ortiz
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