EBQ:PEAPETT Study - Revision history

Cdichang at 08:54, 16 May 2020

2020-05-16T08:54:47Z

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	{{JC info		{{JC info
	\| title= Pulseless electrical activity in pulmonary embolism treated with		\| title= Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the “PEAPETT” study)
	thrombolysis (from the “PEAPETT” study)		\| abbreviation=PEAPETT
	\| abbreviation= PEAPETT ~~study~~		\| expansion=Pulseless electrical activity in pulmonary embolism treated with thrombolysis
	\| expansion=		\| published=2016-6-30
	\| published=		\| author=Sharifi M et al.
	\| author= Sharifi M et al.		\| journal=American Journal of Emergency Medicine
	\| journal= American Journal of Emergency Medicine		\| year=2016
	\| year= 2016		\| volume=34
	\| volume= 34		\| issue=10
	\| issue=		\| pages=1963-1967
	\| pages= 1963-1967
	\| pmid= 27422214		\| pmid= 27422214
	\| fulltexturl= https://www.ajemjournal.com/article/S0735-6757(16)30351-5/fulltext		\| fulltexturl=https://www.ajemjournal.com/article/S0735-6757(16)30351-5/fulltext
	\| pdfurl=		\| pdfurl=
			\| status = Complete
	}}		}}

	==Clinical Question==		==Clinical Question==
	*Does low dose tissue plasminogen activator (tPA) improve survival in patients with pulseless electrical activity and cardiopulmonary arrest due to confirmed pulmonary embolism?		*Does low dose tissue plasminogen activator (tPA) improve survival in patients with pulseless electrical activity and cardiopulmonary arrest due to confirmed pulmonary embolism?

Cdichang: /* Outcomes */

2020-05-16T08:51:05Z

Outcomes

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	==Outcomes==		==Outcomes==


	===Primary Outcome===		===Primary Outcome===
	*ROSC and hemodynamic stability (palpable pulse + systolic BP >100 mm Hg) was achieved 2-15 minutes after tPA in all but 1 patient who died of irreversible shock 10 hours after admission.		*ROSC and hemodynamic stability (palpable pulse + systolic BP >100 mm Hg) was achieved 2-15 minutes after tPA in all but 1 patient who died of irreversible shock 10 hours after admission.
	*Time from CPR to tPA administration was 6.5 ± 2.1 minutes		*Time from CPR to tPA administration was 6.5 ± 2.1 minutes
	*All surviving patients (n=20) reported a return to before event functional capacity without any restrictions that could be attributed to PE		*All surviving patients (n=20) reported a return to before event functional capacity without any restrictions that could be attributed to PE

	===Secondary Outcomes===		===Secondary Outcomes===
	*No major or minor bleeding found on patients with administered tPA during hospitalization or at 22 ± 3 months of follow-up		*No major or minor bleeding found on patients with administered tPA during hospitalization or at 22 ± 3 months of follow-up

Cdichang: /* Funding */

2020-05-16T08:49:13Z

Funding

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	==Funding==		==Funding==
			*Not reported

	==References==		==References==

Cdichang: /* See Also */

2020-05-16T08:48:22Z

Cdichang: /* External Links */

2020-05-16T08:47:24Z

External Links

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	*Study states patients were administered tPA within 6.5 ± 2.1 minutes from initiation of CPR. This is pretty fast. The authors state 17 patients developed cardiopulmonary arrest in the ED, 2 in the ICU, 1 on the floor, and 3 in the radiology department. Unclear what the utility would be of administering tPA in patients with out of hospital arrest with prolonged downtime		*Study states patients were administered tPA within 6.5 ± 2.1 minutes from initiation of CPR. This is pretty fast. The authors state 17 patients developed cardiopulmonary arrest in the ED, 2 in the ICU, 1 on the floor, and 3 in the radiology department. Unclear what the utility would be of administering tPA in patients with out of hospital arrest with prolonged downtime
	*Conflicting literature of tPA use in undifferentiated PEA		*Conflicting literature of tPA use in undifferentiated PEA

	~~==External Links==~~

	==See Also==		==See Also==

Cdichang: /* Criticisms & Further Discussion */

2020-05-16T08:45:38Z

Criticisms & Further Discussion

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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Unblinded study and only performed at a single center
			*No control groups
			*16 of 23 patients had PE diagnosed before tPA administration, only 3 were diagnosed via thrombus seen in right ventricle on POCUS during cardiac arrest
			*Study states patients were administered tPA within 6.5 ± 2.1 minutes from initiation of CPR. This is pretty fast. The authors state 17 patients developed cardiopulmonary arrest in the ED, 2 in the ICU, 1 on the floor, and 3 in the radiology department. Unclear what the utility would be of administering tPA in patients with out of hospital arrest with prolonged downtime
			*Conflicting literature of tPA use in undifferentiated PEA

	==External Links==		==External Links==

Cdichang: /* Major Points */

2020-05-16T08:36:51Z

Major Points

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	==Major Points==		==Major Points==
	*Approximately 8%-13% of unexplained cardiac arrests are due to a massive pulmonary embolism (PE)<ref>Hess EP, Campbell RL, White RD. Epidemiology, trends, and outcome of out-of hospital		*Approximately 8%-13% of unexplained cardiac arrests are due to a massive pulmonary embolism (PE)<ref>Hess EP, Campbell RL, White RD. Epidemiology, trends, and outcome of out-of hospital cardiac arrest of non-cardiac origin. Resuscitation 2007;72:200–6</ref>. Current ACLS and AHA guidelines suggest that thrombolytics should be considered in cardiac arrests that are thought to be secondary to a PE. This study was created to understand better the usage of tPA, efficacy, and safety in cardiopulmonary arrest in confirmed PE. This study was a single-center study of 23 patients on whom the group was consulted. All patients received 50mg tPA IV push during active CPR within 6.5 ± 2.1 minutes from initiation of cardiopulmonary resuscitation. All patients received heparin afterwards. ROSC was achieved in 22/23 patients following 2 to 15 minutes after tPA administration. At two year follow up, 20 patients (87%) were still alive and reported a return to baseline functional capacity without any restrictions. No major or minor bleeding reported.
	cardiac arrest of non-cardiac origin. Resuscitation 2007;72:200–6</ref>. Current ACLS and AHA guidelines suggest that thrombolytics should be considered in cardiac arrests that are thought to be secondary to a PE. This study was created to understand better the usage of tPA, efficacy, and safety in cardiopulmonary arrest in confirmed PE. This study was a single-center study of 23 patients on whom the group was consulted.

	==Study Design==		==Study Design==

Cdichang: /* Outcomes */

2020-05-16T08:27:34Z

Outcomes

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	*ROSC and hemodynamic stability (palpable pulse + systolic BP >100 mm Hg) was achieved 2-15 minutes after tPA in all but 1 patient who died of irreversible shock 10 hours after admission.		*ROSC and hemodynamic stability (palpable pulse + systolic BP >100 mm Hg) was achieved 2-15 minutes after tPA in all but 1 patient who died of irreversible shock 10 hours after admission.
	*Time from CPR to tPA administration was 6.5 ± 2.1 minutes		*Time from CPR to tPA administration was 6.5 ± 2.1 minutes
			*All surviving patients (n=20) reported a return to before event functional capacity without any restrictions that could be attributed to PE

	===Secondary Outcomes===		===Secondary Outcomes===
	*No major or minor bleeding found on patients with administered tPA during hospitalization or at 22 ± 3 months of follow-up		*No major or minor bleeding found on patients with administered tPA during hospitalization or at 22 ± 3 months of follow-up
	*No recurrent VTE in hospital or at follow-up, all surviving patients were on indefinite anticoagulation		*No recurrent VTE in hospital or at follow-up, all surviving patients were on indefinite anticoagulation

	~~===Subgroup analysis===~~

	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

Cdichang: /* Outcomes */

2020-05-16T08:23:25Z

Outcomes

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	===Primary Outcome===		===Primary Outcome===
			*ROSC and hemodynamic stability (palpable pulse + systolic BP >100 mm Hg) was achieved 2-15 minutes after tPA in all but 1 patient who died of irreversible shock 10 hours after admission.
			*Time from CPR to tPA administration was 6.5 ± 2.1 minutes

	===Secondary Outcomes===		===Secondary Outcomes===
			*No major or minor bleeding found on patients with administered tPA during hospitalization or at 22 ± 3 months of follow-up
			*No recurrent VTE in hospital or at follow-up, all surviving patients were on indefinite anticoagulation

	===Subgroup analysis===		===Subgroup analysis===



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

Cdichang: /* Interventions */

2020-05-16T08:16:52Z

Interventions

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	*Within 1 hour of heparin discontinuation, apixaban or rivaroxaban was started orally at maintenance dose		*Within 1 hour of heparin discontinuation, apixaban or rivaroxaban was started orally at maintenance dose
	*Surviving patients were screened for DVT at the second office visit		*Surviving patients were screened for DVT at the second office visit
	*All patients were screened ~~forDVT~~ or PE if there was enough suspicion throughout follow up time		*All patients were screened for DVT or PE if there was enough suspicion throughout follow up time

	==Outcomes==		==Outcomes==

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	==See Also==		==See Also==
			*[[Pulmonary Embolism (PE)]]
			*[[EBQ:MOPETT Trial]]

	==Funding==		==Funding==