Pediatric In-Hospital Cardiac Arrest Secondary to Acute Pulmonary Embolism

Objectives: Pulmonary embolism is a rarely reported and potentially treatable cause of cardiac arrest in children and adolescents. The objective of this case series is to describe the course of five adolescent patients with in-hospital cardiac arrest secondary to pulmonary embolism. Design: Case series. Setting: Single, large academic children’s hospital. Patients: All patients under the age of 18 years (n = 5) who experienced an in-hospital cardiac arrest due to apparent pulmonary embolism from August 1, 2013, to July 31, 2017. Interventions: All five patients received systemic thrombolytic therapy (IV tissue plasminogen activator) during cardiac arrest or periarrest during ongoing resuscitation efforts. Measurements and Main Results: Five adolescent patients, 15–17 years old, were treated for pulmonary embolism–related cardiac arrests during the study period. These accounted for 6.3% of all children and 25% of adolescents (12–17 yr old) receiving at least 5 minutes of in-hospital cardiopulmonary resuscitation during the study period. All five had venous thromboembolism risk factors. Two patients had known, extensive venous thrombi at the time of cardiac arrest, and one was undergoing angiography at the time of arrest. The diagnoses of pulmonary embolism were based on clinical suspicion, bedside echocardiography (n = 4), and low end-tidal CO2 levels relative to arterial CO2 values (n = 5). IV tissue plasminogen activator was administered during cardiopulmonary resuscitation in three patients and after the return of spontaneous circulation, in the setting of severe hemodynamic instability, in the other two patients. Four of five patients were successfully resuscitated and survived to hospital discharge. Conclusions: Pulmonary embolism was recognized as the etiology of multiple adolescent cardiac arrests in this single-center series and may be more common than previously reported. Recognition, high-quality cardiopulmonary resuscitation, and treatment with thrombolytic therapy resulted in survival in four of five patients. Drs. Morgan and Stinson are cofirst authors. Dr. Topjian received support for article research from the National Institutes of Health. Dr. Sutton’s institution received funding from the National Heart, Lung, and Blood Institute; he received funding from Zoll Medical (speaking honoraria); and he disclosed that he is a member of the American Heart Association’s Get with the Guidelines Pediatric Research Task Force. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: morganr1@email.chop.edu Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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