Kürkciyan I, Meron G, Sterz F, Janata K, Domanovits H, Holzer M, Berzlanovich A, Bankl H C, Laggner A N
University Clinic of Emergency Medicine, University of Vienna, Medical School, Wien, Austria.
Arch Intern Med. 2000 May 22;160(10):1529-35. doi: 10.1001/archinte.160.10.1529.
Pulmonary embolism (PE) is a possible noncardiac cause of cardiac arrest. Mortality is very high, and often diagnosis is established only by autopsy.
In a retrospective study, we analyzed clinical presentation, diagnosis, therapy, and outcome of patients with cardiac arrest after PE admitted to the emergency department of an urban tertiary care hospital.
Within 8 years, PE was found as the cause in 60 (4.8%) of 1246 cardiac arrest victims. The initial rhythm diagnosis was pulseless electrical activity in 38 (63%), asystole in 19 (32%), and ventricular fibrillation in 3 (5%) of the patients. Pronounced metabolic acidosis (median pH, 6.95, and lactate level, 16 mmol/L) was found in most patients. In 18 patients (30%), the diagnosis of PE was established only postmortem. In 42 (70%) it was diagnosed clinically, in 24 of them the diagnosis of PE was confirmed by echocardiography. In 21 patients, 100 mg of recombinant tissue-type plasminogen activator was administered as thrombolytic treatment, and 2 (10%) of these patients survived to hospital discharge. Comparison of patients of the thrombolysis group (n = 21) with those of the nonthrombolysis group (n = 21) showed a significantly higher rate of return of spontaneous circulation (81% vs 43%) in the thrombolysis group (P=.03).
Mortality related to cardiac arrest caused by PE is high. Echocardiography is supportive in determining PE as the cause of cardiac arrest. In view of the poor prognosis, thrombolysis should be attempted to achieve return of spontaneous circulation and probably better outcome.
肺栓塞（PE）是心脏骤停可能的非心脏病因。死亡率非常高，且通常仅通过尸检才能确诊。
在一项回顾性研究中，我们分析了一所城市三级医院急诊科收治的因PE导致心脏骤停患者的临床表现、诊断、治疗及预后情况。
8年内，在1246例心脏骤停患者中，有60例（4.8%）被发现病因是PE。患者初始心律诊断为无脉电活动的有38例（63%），心搏停止的有19例（32%），心室颤动的有3例（5%）。大多数患者存在明显的代谢性酸中毒（中位pH值为6.95，乳酸水平为16 mmol/L）。18例患者（30%）仅在死后才确诊为PE。42例（70%）通过临床诊断，其中24例经超声心动图证实为PE。21例患者接受了100 mg重组组织型纤溶酶原激活剂溶栓治疗，其中2例（10%）存活至出院。溶栓组（n = 21）与未溶栓组（n = 21）患者比较，溶栓组自主循环恢复率显著更高（81%对43%，P = 0.03）。
PE所致心脏骤停相关死亡率很高。超声心动图有助于确定PE为心脏骤停的病因。鉴于预后较差，应尝试进行溶栓以实现自主循环恢复并可能获得更好的结局。
