Thrombolytic therapy during or after cardiopulmonary resuscitation. Efficacy and safety of a new therapeutic approach

F Spöhr, B W Böttiger
Minerva Anestesiologica 2003, 69 (5): 357-64
Acute myocardial infarction (MI) and massive pulmonary embolism (PE) are the underlying causes of cardiac arrest in more than 70% of patients. Thrombolysis is an effective therapy for patients presenting with acute MI or massive PE and has experimentally shown to have beneficial effects on the microcirculatory reperfusion after cardiac arrest, but this treatment has been widely withheld up to now mainly because of the fear of severe bleeding complications. To assess the efficacy and safety of thrombolysis after and during cardiopulmonary resuscitation (CPR), we reviewed the currently available clinical studies on thrombolysis after and during CPR. From these data, there is increasing evidence that thrombolytic therapy during or shortly after CPR can contribute significantly to a restoration of spontaneous circulation in patients suffering from cardiac arrest. Although the use of thrombolytic agents is associated with a higher incidence of bleeding complications, currently available data do not suggest an increase of complications if thrombolysis is combined with CPR. Considering the poor outcome of patients suffering from cardiac arrest and the lack of effective and causal treatment options, the potential risks of thrombolysis after or during CPR probably do not outweigh the benefits of this treatment option.

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