Temporal trends in treatment and outcomes of patients with cardiac arrest due to pulmonary embolism: a nationwide inpatient database study.

Abstract

Although cardiac arrest due to pulmonary embolism (PE) is rare, it is associated with extremely high mortality rates. We aimed to describe the patient characteristics, treatment patterns, short-term outcomes, and temporal trends in the management of PE-related cardiac arrest. Data collected between 2012 and 2024 from a nationwide inpatient database in Japan were retrospectively analyzed. Hospitalizations were identified using the diagnostic codes for PE and cardiopulmonary resuscitation. The co-primary outcomes were survival to hospital discharge and favorable neurological outcomes at discharge. Temporal trends in treatment patterns and outcomes were analyzed. A total of 10,390 patients with PE who underwent cardiopulmonary resuscitation were identified. The median patient age was 74 years, and 44.4% of the patients were men. Extracorporeal membrane oxygenation (ECMO) was used in 18.4% of the patients, and thrombolytic therapy (TL) was used in 11.1%. Overall, 22.5% of the patients survived to hospital discharge, and 18.5% had favorable neurological outcomes at discharge. TL use decreased from 16.0% in 2012 to 6.7% in 2023 (p < 0.001), whereas ECMO use increased from 16.0% to 20.8% (p = 0.015). Survival increased from 20.9% to 24.1% (p = 0.04), and favorable neurological outcomes increased from 17.4% to 20.6% (p = 0.04). Trend subgroup analyses revealed that improvements in survival and neurological outcomes were particularly evident in both patients with hospital-acquired PE and those treated with ECMO. From 2012 to 2024, TL use decreased, whereas ECMO use increased. The survival and neurological outcomes improved over time, particularly in patients with hospital-acquired PE and those who received ECMO.