In-hospital cardiac arrest due to pulmonary embolism – Treatment and outcomes in a Swedish cohort study

OBJECTIVES: Pulmonary embolism (PE) constitutes one of the reversible causes of cardiac arrest. The prognosis for PE-related cardiac arrest is poor. Some previous studies have suggested a higher survival rate in patients with PE-related cardiac arrest who receive thrombolysis. No such study has focused on in-hospital cardiac arrests (IHCA). AIM: To describe the prevalence of PE-related IHCA and the characteristics of those patients, as well as to describe favourable and adverse outcomes after thrombolysis. MATERIAL AND METHODS: All patients ≥ 18 years who experienced an IHCA at Karolinska University Hospital between 2007 and 2020 with PE as the primary cause of IHCA were included. Patients were identified from the Swedish Registry for Cardiopulmonary Resuscitation (SRCR). Data was collected from the SRCR and medical records. The primary outcome was survival to discharge. Secondary outcomes were alive at the end of CPR, major bleeding, and minor bleeding. RESULTS: Out of 2,128 IHCA patients, 64 (3%) had a PE-related IHCA of whom 16 (25%) had thrombolysis. A significant association was seen between thrombolysis and survival to discharge (44 % vs 8 %, p-value < 0.01). Major bleeding was not seen in any patient. CONCLUSION: Pulmonary embolism is an uncommon cause of IHCA, and thrombolysis is often not administered in such patients. Thrombolysis may increase survival to hospital discharge, and among the selected patients treated with thrombolysis in our study, there was no apparent major bleeding.