Titanic and D-Dimer

Forget adrenaline! Forget compressions! What we really need in the middle of a code? Yet another "45-min" lab value to tell us whether our heroic efforts are heading anywhere.

Enter stage left: D-dimer.

Physiopathologically, there’s something going on — and there’s a reason D-dimer is often elevated (even if it won’t reliably rule in a PE).

During cardiac arrest, widespread endothelial injury activates the coagulation cascade intensely, leading to intravascular fibrin formation and subsequent fibrinolysis. This results in elevated circulating levels of D-dimer, a marker of fibrin degradation. 

It’s the circle of life... just reversed — and more dramatic.

Now, before anyone gets carried away take this: a D-dimer level over 5,205 µg/L on admission isn’t just “elevated.” It’s independently associated with 30-day mortality, with an odds ratio of 5.7.

So, It might not tell you something clear, but it’s definitely trying to warn you about the iceberg ahead.

🩸Buchtele, N., Schober, A., Schoergenhofer, C., Spiel, A. O., Mauracher, L., Weiser, C., Sterz, F., Jilma, B., & Schwameis, M. (2018). Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest. European journal of internal medicine, 57, 44–48. https://doi.org/10.1016/j.ejim.2018.06.016