Wulfran Bougouin1, Eloi Marijon1, Benjamin Planquette2, Nicole Karam1, Florence Dumas3, David S Celermajer4, Daniel Jost5, Lionel Lamhaut6, Frankie Beganton7, Alain Cariou8, Guy Meyer9, Xavier Jouven10. 1. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France. 2. Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Department of Respiratory Disease, Georges Pompidou European Hospital, AP-HP, Paris, France; INSERM U UMRS 1140, Paris, France. 3. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France. 4. Sydney Medical School, Australia. 5. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Brigade de Sapeurs Pompiers de Paris (BSPP), Paris, France. 6. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France. 7. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France. 8. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris Cedex 14, France. 9. Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Department of Respiratory Disease, Georges Pompidou European Hospital, AP-HP, Paris, France; INSERM UMRS 970 and CIC 1418, Paris, France. 10. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France. Electronic address: xavier.jouven@inserm.fr.
Abstract
AIM: Pulmonary Embolism (PE) is a relatively common cardiovascular condition, occasionally and tragically manifesting as Sudden Cardiac Arrest (SCA). The natural history of SCA complicating PE has been poorly evaluated.In this study, we described the management and outcome of PE-related SCA. METHODS: In this prospective population--based study, we included all patients admitted at hospital alive after out- of- hospital SCA, in Paris and suburbs, France (6.6 million inhabits), from May 2011 to September 2015. RESULTS: Of 2926 patients hospitalized after SCA, 82 cases were diagnosed as PE-related SCA (2.8%, 95%CI=2.2-3.4). Systemic thrombolysis was performed in 47 patients (57%), without significant increased risk of major bleeding among patients treated with thrombolysis. 12 patients (15%) were treated with ECLS, 29 patients (36%) had targeted temperature management, and 20 patients (24%) underwent coronary angiography. 94% of PE-related SCA had initial non-shockable rhythm, and were associated with better survival compared with other non-shockable SCA (crude OR=3.0, 95%CI=1.7-5.4, P <0.001; adjusted OR=4.1, 95%CI 2.0-8.3, P<0.001). Among PE-related SCA, thrombolysis was independently associated with survival (OR=12.5, 95%CI=1.8-89.1, P=0.01). Multiple sensitivity analysis was performed, with consistent results. CONCLUSIONS: PE is responsible of approximately 3% of hospitalizations for SCA. Thrombolysis was associated with an increased survival in this population, reinforcing current guidelines advocating for such treatment in PE-related SCA.
AIM: Pulmonary Embolism (PE) is a relatively common cardiovascular condition, occasionally and tragically manifesting as Sudden Cardiac Arrest (SCA). The natural history of SCA complicating PE has been poorly evaluated.In this study, we described the management and outcome of PE-related SCA. METHODS: In this prospective population--based study, we included all patients admitted at hospital alive after out- of- hospital SCA, in Paris and suburbs, France (6.6 million inhabits), from May 2011 to September 2015. RESULTS: Of 2926 patients hospitalized after SCA, 82 cases were diagnosed as PE-related SCA (2.8%, 95%CI=2.2-3.4). Systemic thrombolysis was performed in 47 patients (57%), without significant increased risk of major bleeding among patients treated with thrombolysis. 12 patients (15%) were treated with ECLS, 29 patients (36%) had targeted temperature management, and 20 patients (24%) underwent coronary angiography. 94% of PE-related SCA had initial non-shockable rhythm, and were associated with better survival compared with other non-shockable SCA (crude OR=3.0, 95%CI=1.7-5.4, P <0.001; adjusted OR=4.1, 95%CI 2.0-8.3, P<0.001). Among PE-related SCA, thrombolysis was independently associated with survival (OR=12.5, 95%CI=1.8-89.1, P=0.01). Multiple sensitivity analysis was performed, with consistent results. CONCLUSIONS: PE is responsible of approximately 3% of hospitalizations for SCA. Thrombolysis was associated with an increased survival in this population, reinforcing current guidelines advocating for such treatment in PE-related SCA.
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