Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Thrombolytics in Cardiac Arrest: Is It Beneficial in Confirmed or Suspected PE?

Session Title
TP88 - TP088 LUCY IN THE SKY WITH DIAMONDS - PULMONARY EMBOLISM, CTEPH, THROMBOSIS, AND COVID19: CLINICAL ADVANCES
Abstract
A3720 - Thrombolytics in Cardiac Arrest: Is It Beneficial in Confirmed or Suspected PE?
Author Block: S. Gayen1, F. Dikengil1, M. Zheng1, A. Katz2, B. Kwok3, S. Brosnahan3, P. Rali1; 1Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Pharmacy, NYU Langone Health, New York, NY, United States, 3Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States.
Rationale: Thrombolysis is standard of care in management of massive PE. However, the role and dosing of thrombolytics in massive PE related cardiac arrest remains controversial. Less evidence exists for the benefit of thrombolysis in cardiac arrest when PE is suspected but not confirmed. Despite this, the American Heart Association (AHA) guidelines for ACLS cite thrombolysis during cardiac arrest as a class IIa recommendation in confirmed PE and a class IIb recommendation in suspected PE. We aim to review the benefits of thrombolysis when used in cardiac arrest setting where PE was suspected or confirmed.
Methods: Data was collected from a retrospective review of our double center PE response team patient databases from 2017 to 2019. Sixty-eight patients were identified that received pharmacologic thrombolysis with tissue plasminogen activator (tPA) during in-hospital cardiac arrest. They were stratified by whether PE was confirmed or presumed. Successful achievement of ROSC and 30-day survival were the main outcomes assessed.
Results: We identified sixty-eight patients who received tPA during cardiac arrest (Table 1). Twenty-three patients (34%) in total achieved ROSC, with eight (11%) achieving 30-day survival. Of those sixty-eight patients, twenty-one patients received tPA for confirmed PE and forty-seven patients received tPA for presumed PE. Thirteen patients (62%) with confirmed PE achieved ROSC, with four (19%) achieving 30-day survival. Ten patients (21%) with presumed PE achieved ROSC, with four (9%) reaching 30-day survival.
Conclusions: Cardiac arrest has a low rate of successful resuscitation, regardless of etiology. Despite limited evidence, the use of thrombolytics during cardiac arrest for confirmed and presumed PE is recommended in the AHA guidelines for ACLS. We found that patients with confirmed PE related cardiac arrest had higher rates of ROSC when receiving tPA as compared to those with presumed PE (62% vs. 21%). Overall 30-day survival is extremely low in both the groups. Thrombolytic therapies should be very selectively administered in non-confirmed VTE cases. On the other end, patients with PE should be better triaged with PERT teams to have early recognition and intervention to prevent a cardiac arrest situation.