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Resuscitation group should be a part of all pulmonary thromboembolism risk stratifications

      Pulmonary thromboembolism (PTE) is manifested in numerous ways, from asymptomatic and/or incidentaloma to being fatal. Because the symptoms and signs are not specific, PTE has been named as “the chameleon”. Together with this, the prevalent co-morbidities cause a delay in the correct diagnosis thereby postponing the necessary timely treatment (that can be life-saving) [
      • van der Pol L.M.
      • Dronkers C.E.A.
      • van der Hulle T.
      • den Exter P.L.
      • Tromeur C.
      • Heringhaus C.
      • et al.
      The YEARS algorithm for suspected pulmonary embolism: shorter visit time and reduced costs at the Emergency department.
      ]. From the number of patients who die because of PTE, the majority do so prior to reaching the hospital [
      • Yamamoto T.
      • Sato N.
      • Tajima H.
      • Takagi H.
      • Morita N.
      • Akutsu K.
      • et al.
      Differences in the clinical course of acute massive and submassive pulmonary embolism.
      ]. Therefore, a significant proportion of patients with cardiac arrest is because of PTE: 2–13% of arrests occur out of the hospital and 5–6% of those occurring in the hospital [
      • Truhlář A.
      • Deakin C.D.
      • Soar J.
      • Khalifa G.E.
      • Alfonzo A.
      • Bierens J.J.
      • et al.
      Cardiac arrest in special circumstances section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: section 4. Cardiac arrest in special circumstances.
      ,
      • Sharifi M.
      • Berger J.
      • Beeston P.
      • Bay C.
      • Vajo Z.
      • Javadpoor S.
      • et al.
      Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the “PEAPETT” study).
      ,
      • Laher A.E.
      • Richards G.
      Cardiac arrest due to pulmonary embolism.
      ]. No less than 30% of such patients had been misdiagnosed [
      • Laher A.E.
      • Richards G.
      Cardiac arrest due to pulmonary embolism.
      ,
      • Kürkciyan I.
      • Meron G.
      • Sterz F.
      • Janata K.
      • Domanovits H.
      • Holzer M.
      • et al.
      Pulmonary embolism as a cause of cardiac arrest: presentation and outcome.
      ]. The pulseless electrical activity (PEA) had been found in 63% of PTE patients with cardiac arrest, asystole in 32% and ventricular fibrillation in 5% [
      • Laher A.E.
      • Richards G.
      Cardiac arrest due to pulmonary embolism.
      ,
      • Kürkciyan I.
      • Meron G.
      • Sterz F.
      • Janata K.
      • Domanovits H.
      • Holzer M.
      • et al.
      Pulmonary embolism as a cause of cardiac arrest: presentation and outcome.
      ]. This group of resuscitated PTE patients has a bleak prognosis [
      • Laher A.E.
      • Richards G.
      Cardiac arrest due to pulmonary embolism.
      ]. The question of fibrinolytic effect in PTE patients with cardiac arrest has been an important topic and a challenging task for years [
      • Goran K.P.
      Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism.
      ].

      Keywords

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