[Emergency medicine and myocardial ischaemia - thrombolysis during cardiopulmonary resuscitation - available data and recommendations]

Fabian Spöhr, Bernd W Böttiger
Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 2008, 43 (3): 226-30; quiz 231
Patients suffering cardiac arrest still have a poor prognosis. Up to the present, no drug therapy has shown to improve longterm survival after cardiac arrest. Acute myocardial infarction (AMI) or massive pulmonary embolism (PE) are the underlying causes for sudden cardiac arrest in 50-70 % of patients. Thrombolysis is an effective and causal therapy in patients with AMI or PE. Therefore, combining cardiopulmonary resuscitation (CPR) with thrombolysis may be a promising therapeutic approach. Experimental studies have demonstrated that thrombolytic therapy during CPR is not only a causal treatment for coronary or pulmonary arterial thrombi, but may also improve microcirculatory reperfusion after cardiac arrest. Although numerous case series and small clinical studies showed evidence for the success of thrombolytic therapy during CPR, a large randomised study did not confirm these results. Thrombolysis during CPR today can not be recommended as a standard therapy in patients suffering cardiac arrest. However, it should be considered if a massive PE is supposed to be the cause of cardiac arrest or if conventional CPR has not been successful in a patient with presumed thrombotic cause of cardiac arrest. The expected bleeding risk is outweighed by the potential benefit of this therapy in selected patients.

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