Pulseless Electrical Activity: Patient Outcomes with Alteplase Administration in Cardiac Arrest

Purpose: The purpose of this study was to evaluate the timing of fibrinolytic administration post-arrest onset and its effect on patient outcomes including arrest survival.
Methods: We performed a single center, retrospective chart review of patients receiving alteplase for PEA arrest. Outcomes were evaluated in a sub-group of patients, code survivors versus non-survivors. Primary outcome was time period from arrest onset to alteplase administration and its effect on survival. Secondary outcomes included: alteplase dose administered, resuscitation duration postalteplase administration and return of spontaneous circulation (ROSC) following fibrinolysis. Safety outcomes included the incidence of major and minor bleeding events.
Results: Twenty-seven PEA arrest patients were included. Average time from code onset to alteplase administration was 28 ± 12.5 minutes in the overall cohort. Patients who survived the code (n=5) were administered alteplase within 19.2 ± 10.1 minutes of arrest onset compared with an average post-arrest administration time of 30.1 ± 12.2 minutes in non-survivors (n=22). The mean duration of resuscitation post-alteplase administration was 9 ± 3.7 minutes in the patients who survived versus 12.5 ± 19.0 minutes in patients who expired during the code. There were three major and one minor bleeding event.
Conclusion: We found a high mortality rate in patients with PEA during cardiac arrest. Early alteplase administration was not associated with a statistically significant improvement in patient outcomes including ROSC and code survival. Future studies with larger sample sizes are needed to detect smaller clinically significant differences in code survival with earlier alteplase administration.

Author(s): Jillian T Dempsey, Iwona Rybak, Patricia Krause, John Fanikos and Katelyn Sylvester

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