Development and implementation of an emergency alteplase kit for high-risk pulmonary embolism in cardiac arrest

The basis of cardiac arrest management involves quality chest compressions, early defibrillation, and immediate treatment of any potential reversible causes such as electrolyte derangements, tamponade physiology, toxins, and thrombosis.1,2 High-risk pulmonary embolism (PE) accounts for approximately 5% of inpatient cardiac arrests and is attributed a mortality rate of up to 95%.3,4 The limited data available suggest increased rates of return of spontaneous circulation (ROSC) with thrombolytic therapy, and the 2020 American Heart Association guidelines suggest administration of thrombolytic drugs for cardiac arrest when PE is the suspected cause.5,6 Timely provision of thrombolytic therapy during cardiac arrest poses numerous institutional challenges given the risks associated with inappropriate use and administration of a high-alert medication in a high-stress situation. Before the availability of a PE kit at our institution, we were faced with several challenges when providing thrombolytic therapy, such as delays associated with order entry and a lack of familiarity with proper reconstitution and administration. The purpose of this article is to describe key clinical and operational considerations during the development and implementation of an emergency alteplase kit for suspected high-risk PE in cardiac arrest at an academic medical center.