Cardiac arrest carries a very poor prognosis. More than 70% of cardiac arrests are caused by acute
myocardial infarction (AMI) or massive
pulmonary embolism (PE). Thrombolysis during
CPR has two major effects: first, it causally treats the condition that caused
cardiac arrest and second, it has been shown to have beneficial effects on the microcirculatory cerebral reperfusion after
cardiac arrest. However, this treatment has been widely withheld mainly because of the fear of severe
bleeding complications. We reviewed the currently available in- and out-of-hospital studies on thrombolysis during
CPR. Most studies found that
thrombolytic therapy during
CPR improves the chance for a restoration of spontaneous circulation in patients suffering from
cardiac arrest and may even result in a better outcome. In addition, the neurological condition of surviving patients may be markedly improved by thrombolysis. Although
thrombolytic therapy is associated with a risk of
bleeding complications, currently available data do not suggest an increase of
bleeding complications if thrombolysis is administered during
CPR. Recently, a large randomized multicentre study has started to assess the efficacy and safety of thrombolysis during prehospital
CPR.