Table 1.
Patient characteristics, tPA administration, and outcomes
| Characteristic | tPA Recipients (n = 59) |
|---|---|
| Demographics | |
| Age, yr, median (IQR) | 60 (50–67) |
| Sex, M, n (%) | 43 (72.9) |
| Race, n (%) | |
| White | 19 (32.2) |
| Black | 13 (22.0) |
| Other or unknown | 27 (45.8) |
| Hispanic, n (%) | 18 (30.5) |
| BMI, median (IQR) | 32.2 (27.6–36.8) |
| Comorbidities, n (%) | |
| Diabetes mellitus | 21 (35.6) |
| Hypertension | 34 (57.6) |
| COPD | 4 (6.8) |
| Current or former smoker | 14 (23.4) |
| Coronary artery disease | 6 (10.2) |
| Atrial fibrillation or atrial flutter | 5 (8.5) |
| Congestive heart failure | 3 (5.1) |
| Chronic kidney disease | 3 (5.1) |
| Laboratory values at tPA receipt, median (IQR) | |
| Leukocyte count/mm3 | 11.6 (8.2–15.7) |
| Hemoglobin, g/dl | 13.1 (11.3–13.8) |
| Platelet count/mm3 | 254 (211–313) |
| D-dimer, ng/ml | 10,000 (3,382–25,966) |
| Lactate, mmol/L | 2.3 (1.6–3.4) |
| C-reactive protein, mg/L | 148 (74–258) |
| Ferritin, ng/ml | 1,094 (639–2,048) |
| Fibrinogen, mg/dl | 649 (484–796) |
| International normalized ratio | 1.3 (1.2–1.4) |
| Partial thromboplastin time, s | 36.5 (29.5-68.9) |
| Severity of illness at tPA receipt, n (%) | |
| Invasive mechanical ventilation | 58 (98.3) |
| Vasopressors | 43 (72.9) |
| Acute renal replacement therapy | 8 (13.6) |
| VV-ECMO | 1 (1.7) |
| Therapeutic-dose anticoagulation at tPA receipt, n (%) | |
| Any | 42 (71.2) |
| Heparin infusion | 25 (42.4) |
| Enoxaparin | 17 (28.8) |
| tPA indication, n (%) | |
| Suspected pulmonary embolism | 47 (79.7) |
| Confirmed pulmonary embolism | 12 (20.3) |
| tPA administration, median (IQR) | |
| Days from ICU admission to tPA receipt | 6 (0–14) |
| Cumulative dose, mg | 50 (50–100) |
| Initial bolus dose, mg | 50 (25–100) |
| Infusion time, h | 2 (1–2) |
| Administered during cardiac arrest, n (%) | 6 (10.2) |
| Major bleeding | |
| Major bleeding with 7 d after tPA, n (%) | 6 (10.2) |
| Characteristics of bleeding, n/n bleed (%) | |
| Site of major bleed | |
| Bronchopulmonary | 2/6 (33.3) |
| Central nervous system | 1/6 (16.7) |
| Gastrointestinal | 1/6 (16.7) |
| Mucocutaneous | 2/6 (33.3) |
| Invasive hemostatic intervention for bleeding | 2/6 (33.3) |
| Received red cell transfusion for bleeding | 2/6 (33.3) |
| Therapeutic anticoagulation at time of tPA | 5/6 (83.3) |
| Antiplatelet therapy at time of tPA | 0/6 (0) |
| Major bleed clearly fatal or important contributor to death | 3/6 (50.0) |
| Cumulative dose of tPA, mg, median (IQR) | 50 (50-88) |
| Oxygenation and ventilation pre-tPA/post-tPA* | |
| PaO2, mm Hg, median (IQR) | 84 (60–107) / 80 (56–103) |
| FiO2, median (IQR) | 0.9 (0.6–1.0) / 1.0 (0.7–1.0) |
| PaO2:FiO2, median (IQR) | 86 (69–157) / 102 (67–174) |
| PaCO2, mm Hg, median (IQR) | 52 (45–71) / 54 (44–71) |
| Tidal volume, ml, median (IQR) | 420 (385–500) / 440 (368–500) |
| Respiratory rate, breaths/min, median (IQR) | 29 (22–30) / 30 (25–33) |
| Minute ventilation, L, median (IQR) | 12.2 (10.0–14.6) / 12.8 (10.1–14.4) |
| Dead space, physiologic, ml, median (IQR) | 297 (229-411) / 308 (236-388) |
| Therapies for refractory hypoxemia pre-tPA/post-tPA, n (%)† | |
| Prone positioning | 22 (37.2) / 16 (27.1) |
| Neuromuscular blockade | 17 (28.8) / 20 (35.6) |
| Inhaled pulmonary vasodilators‡ | 12 (20.3) / 12 (20.3) |
| At least one therapy | 30 (50.8) / 30 (50.8) |
| At least two therapies | 14 (23.7) / 14 (23.7) |
| Number of vasopressors pre-tPA/post-tPA, n (%)† | |
| 0 | 23 (39.0) /14 (23.7) |
| 1 | 20 (33.9) / 11 (18.6) |
| 2 | 8 (13.6) / 11 (18.6) |
| ⩾2 | 8 (13.6) / 26 (39.0) |
| VIS, median (IQR) | |
| 0 h | 6.0 (0–20.0) |
| 6 h | 7.6 (0–20.3) |
| 12 h | 5.3 (0–21.0) |
| 24 h | 3.3 (0–14.9) |
| Outcomes | |
| In-hospital death, n (%) | 45 (76.3) |
| Discharged alive, n (%) | 14 (23.7) |
| Length of stay among survivors, d, median (IQR) | 13 (3–38) |
| Increase in PaO2:FiO2 ratio ⩾ 50%, n (%)* | 8/42 (19.0) |
| Causes of Death, n (%)§ | |
| Respiratory failure | 40 (88.9) |
| Septic shock | 25 (55.6) |
| Heart failure | 8 (17.8) |
| Renal failure | 15 (33.3) |
| Hepatic failure | 2 (4.4) |
| Other | 12 (26.7) |
| Previously reported, n (%)ǁ | 17 (28.8) |
Definition of abbreviations: BMI = body mass index; COPD = chronic obstructive pulmonary disease; ICU = intensive care unit; IQR = interquartile range; PaCO2 = partial pressure of carbon dioxide; PaO2:FiO2 = ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; tPA = tissue plasminogen activator; VIS = vasoactive-inotropic score; VV-ECMO = venovenous extracorporeal membrane oxygenation.
Oxygenation and ventilation values before and after tPA are derived from the closest arterial blood gas obtained within 48 hours before and after tPA receipt, respectively. These data were available for 42 of the 59 patients (71.2%) in the cohort.
Therapies for refractory hypoxemia and number of vasopressors before and after tPA were assessed within 24 hours before and 24 hours after tPA receipt, respectively.
Inhaled pulmonary vasodilators include epoprostenol and nitric oxide.
Patients may have had more than one cause of death.