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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.