title: Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Thrombolytic therapy during cardiopulmonary resuscitation (CPR) is a controversial issue in emergency medicine practice. This study was conducted to determine whether administration of recombinant tissue plasminogen activator (rt-PA) in out-of-hospital cardiac arrest of non-traumatic aetiology improves CPR outcome.
  
  
  RESULTS
  A retrospective chart review of 401 patients with out-of-hospital cardiac arrest who were resuscitated by the emergency medical services (EMS) during a 6 year period was performed. A total of 108 patients received rt-PA during CPR and were compared to 216 controls, closely matched according to baseline characteristics, arrival status and ECG findings. Administration of rt-PA was optional. Return of spontaneous circulation (ROSC) occurred in 76 patients under rt-PA treatment (70.4 vs. 51.0% in controls; P=0.001). Fifty-two patients from the lysis group survived the first 24 h (48.1 vs. 32.9% in controls; P=0.003), while 27 (25.9%) survived to discharge. Autopsy reports revealed major bleeding complications in six patients receiving rt-PA treatment. Fulminant intracranial haemorrhage was observed in one patient who received rt-PA and in two cases from the control group.
  
  
  CONCLUSIONS
  Thrombolytic therapy may improve frequency of return of spontaneous circulation substantially and increase primary survival in patients with non-traumatic cardiac arrest. Serious bleeding complications are not frequently observed under rt-PA treatment.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, 35, Anichstr. A-6020 Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Lederer
authors.forename: C
authors.initials: C
authors.lastname: Lichtenberger
authors.forename: C
authors.initials: C
authors.lastname: Pechlaner
authors.forename: G
authors.initials: G
authors.lastname: Kroesen
authors.forename: M
authors.initials: M
authors.lastname: Baubin
mesh_terms: D000368:Aged; D001775:Blood Circulation / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006470:Hemorrhage / Q000139:chemically induced*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator