Abstract | OBJECTIVE: METHODS: An observational cohort study of medical OOHCA patients in an urban emergency medical services (EMS) system. Subjects were patients>or=18 years suffering medical OOHCA. Citrated blood samples were drawn in the prehospital setting either directly from venous blood or during the placement of a central venous catheter and frozen (-70 degrees C). The EMS physician documented age, gender, time intervals, return of spontaneous circulation (ROSC), therapies administered and time of blood draw. TAT assays were performed by commercial ELISA. RESULTS: Eighty-eight patients (58% male) aged 63.4+/-15.9 years were enrolled in the study. Median [interquartile range IQR] TAT values in 80 samples (8 samples were grossly clotted and excluded) were 159.2 [38, 2, 522, 8] and ranged from 0.79 to 1,343.9. Patients transported to the hospital had lower TAT levels than those pronounced in the field (p=0.014). Of four EMS-witnessed arrests, three had return of pulses with TAT values of 0.79, 6.8, and 17.9. The fourth had a TAT over 525 after a long unsuccessful resuscitation. For subjects with TAT below 50 (n=23), all but three were witnessed arrests or received bystander CPR. CONCLUSIONS: Except for a single case witnessed by EMS and immediately defibrillated into a perfusing rhythm, all cases of OOHCA exhibited increased thrombotic state. Intravascular thrombosis may represent a global barrier to resuscitation and ultimately, end-organ perfusion.
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Authors | David Hostler, Clifton W Callaway, David H Newman, Brian D'Cruz |
Journal | Prehospital emergency care
(Prehosp Emerg Care)
2007 Jan-Mar
Vol. 11
Issue 1
Pg. 9-13
ISSN: 1090-3127 [Print] England |
PMID | 17169869
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Aged
- Antithrombins
(analysis)
- Cohort Studies
- Emergency Medical Services
- Female
- Heart Arrest
(physiopathology)
- Humans
- Male
- Middle Aged
- Pennsylvania
- Thrombin
(analysis)
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