![]() ![]() For the interval from cardiac arrest to the beginning of basic and/or advanced life support, we presumed sufficient systemic blood flow to be absent ("no-flow time"). 17, 18 The following data concerning cardiac arrest and CPR were documented on arrival: sex and age of the patients location of cardiac arrest (out of hospital vs in hospital) initial electrocardiogram (ECG) rhythm observed by any rescue worker, distinguishing between ventricular fibrillation, asystole, or pulseless electrical activity/electromechanical dissociation (PEA/EMD) and time until restoration of spontaneous circulation. 16 The study procedures followed were in accord with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983.Īccording to the criteria of the American Heart Association, cardiac arrest was defined as sudden collapse, followed by loss of consciousness and absence of both spontaneous respiration and pulse, that required CPR. In a retrospective study, we analyzed the data of all patients with cardiac arrest caused by PE admitted to our emergency department, including clinical characteristics, diagnostic methods, therapeutic management, and outcome.įrom July 1, 1991, to June 30, 1999, data for all patients admitted to the University Clinic of Emergency Medicine of the University of Vienna, Medical School, Vienna, Austria, after either in-hospital or out-of-hospital cardiac arrest were documented according to a specific protocol (Utstein style). Therapies such as thrombolysis 7 - 9 or surgical embolectomy 10 - 15 are presumed to reduce mortality, and both methods have been performed even in ongoing CPR situations, either alone or in combination. Circulatory failure occurs through a profound decrease in left ventricular preload. Overload of the right ventricle results in a leftward shift of the ventricular septum, leading to decreased left ventricular diastolic filling and end-diastolic volume. As the right ventricle fails, right atrial pressure rises and cardiogenic shock ensues. ![]() The mechanism of cardiac arrest caused by PE is based on pulmonary mainstream obstruction and liberation of vasoconstrictive mediators from the thrombi, leading to increased right ventricular afterload. 1 Therefore, most of these patients will require cardiopulmonary resuscitation (CPR) well before any attempt to diagnose the cause of cardiac arrest has been made, and in many cases the diagnosis will be established only by autopsy after unsuccessful CPR. In fulminant PE, up to 90% of cardiac arrests occur within 1 to 2 hours after the onset of symptoms. PULMONARY embolism (PE) is a possible noncardiac cause of cardiac arrest and has an extremely unfavorable prognosis. In view of the poor prognosis, thrombolysis should be attempted to achieve return of spontaneous circulation and probably better outcome. Echocardiography is supportive in determining PE as the cause of cardiac arrest. Comparison of patients of the thrombolysis group (n=21) with those of the nonthrombolysis group (n=21) showed a significantly higher rate of return of spontaneous circulation (81% vs 43%) in the thrombolysis group ( P=.03).Ĭonclusions Mortality related to cardiac arrest caused by PE is high. ![]() In 21 patients, 100 mg of recombinant tissue-type plasminogen activator was administered as thrombolytic treatment, and 2 (10%) of these patients survived to hospital discharge. In 42 (70%) it was diagnosed clinically, in 24 of them the diagnosis of PE was confirmed by echocardiography. In 18 patients (30%), the diagnosis of PE was established only postmortem. Pronounced metabolic acidosis (median pH, 6.95, and lactate level, 16 mmol/L) was found in most patients. The initial rhythm diagnosis was pulseless electrical activity in 38 (63%), asystole in 19 (32%), and ventricular fibrillation in 3 (5%) of the patients. Results Within 8 years, PE was found as the cause in 60 (4.8%) of 1246 cardiac arrest victims. Methods In a retrospective study, we analyzed clinical presentation, diagnosis, therapy, and outcome of patients with cardiac arrest after PE admitted to the emergency department of an urban tertiary care hospital. Mortality is very high, and often diagnosis is established only by autopsy. Shared Decision Making and Communicationīackground Pulmonary embolism (PE) is a possible noncardiac cause of cardiac arrest.Scientific Discovery and the Future of Medicine. ![]()
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