Characterization of alteplase therapy for presumed or confirmed pulmonary embolism during cardiac arrest

The dosing and administration of alteplase in cardiac arrest due to suspected or confirmed pulmonary embolism (PE) are characterized.

This multicenter, retrospective, cohort study evaluated adult patients who received alteplase during PE-induced cardiac arrest at 16 medical centers. Outcomes analyzed included alteplase dosing characteristics, cardiopulmonary resuscitation survival, time to return of spontaneous circulation (ROSC), documented occurrence of major or minor bleeding, intensive care unit and hospital length of stay, and survival to discharge.

A total of 35 patients were included in the analysis. Forty-six percent of patients received alteplase by a bolus-only dosing strategy. The most common bolus-only alteplase dose was 50 mg. Patients in the bolus-only group had a significantly shorter mean time from cardiac arrest onset to alteplase administration (15.1 minutes) compared with both the infusion-only group (46.4 minutes) and the bolus-with-infusion group (48.0 minutes) (p = 0.006). The mean cumulative alteplase dose was significantly higher in patients who had ROSC than those who did not (90.6 and 69.4 mg, respectively; p = 0.03). Although there was a significant difference in the cardiac arrest survival between groups, there was no difference between dosing strategies and the attainment of ROSC, and survival to hospital discharge.

Among patients receiving alteplase for presumed or confirmed PE during cardiac arrest, the most common treatment was administration of a single 50-mg bolus of the thrombolytic agent. This treatment was received by all survivors of cardiac arrest.