Out-of-hospital thrombolysis during cardiopulmonary resuscitation in patients with high likelihood of ST-elevation myocardial infarction.

Abstract

Up to 90% of cardiac arrests are due to acute myocardial infarction or severe myocardial ischaemia. Thrombolysis is an effective treatment for ST-elevation myocardial infarction (STEMI), but there is no evidence or guideline to put forward a thrombolysis strategy during cardiopulmonary resuscitation (CPR). In two physician-manned emergency medical service (EMS) units in Berlin, Germany, using thrombolysis is based on an individual judgment of the EMS physician managing the CPR attempt. In this retrospective analysis over 3 years (total 22.164 scene calls), thrombolysis was started at the scene in 50 patients during brief intermittent phases of spontaneous circulation, and in 3 patients during ongoing CPR. On-scene diagnosis of myocardial infarction was established in 45 patients (85%) by a 12-lead ECG, 5 (9%) patients had a left bundle branch block. Sixteen patients (30%) died at the scene, 37 patients (70%) were admitted to a hospital. In-hospital mortality was 35% (13 of 37 patients), with cause of death being cardiogenic shock in nine patients, hypoxic cerebral coma in two and acute haemorrhage in two other patients. All 24 of 53 (45%) survivors were discharged with an excellent neurological recovery. CPR was started by an EMS physician in 18 of the 24 survivals (75%) and emergency medical technicians who arrived first in six (25%). Duration of CPR until return of spontaneous circulation was <10 min in 13 of 24 (54%) of the survivors. Thrombolysis was initiated during intermittent phases of spontaneous circulation in 50 (94%) of all patients and in 23 (96%) of the 24 survivors. In conclusion, this retrospective analysis shows excellent survival rates and neurological outcome in selected patients with a high likelihood of myocardial infarction, who develop cardiac arrest and are treated with thrombolysis.

• Authors: Hans-Richard Arntz, Volker Wenzel, Rüdiger Dissmann, Angela Marschalk, Jan Breckwoldt, Dirk Müller
• Journal: Resuscitation (Resuscitation) Vol. 76 Issue 2 Pg. 180-4 (Feb 2008) ISSN: 0300-9572 [Print] Ireland
• PMID: 17728040 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Streptokinase
• Aspirin

Topics

• Aspirin (administration & dosage)
• Cardiopulmonary Resuscitation (methods)
• Drug Therapy, Combination
• Emergency Medical Services (methods)
• Female
• Fibrinolytic Agents (administration & dosage)
• Follow-Up Studies
• Germany (epidemiology)
• Heart Arrest (etiology, mortality, therapy)
• Humans
• Injections, Intravenous
• Male
• Middle Aged
• Myocardial Infarction (complications, drug therapy, physiopathology)
• Outpatients
• Retrospective Studies
• Risk Factors
• Streptokinase (administration & dosage)
• Survival Rate
• Thrombolytic Therapy (methods)
• Time Factors
• Treatment Outcome