Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest.
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.
Lederer
W
W
Department of Anaesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, 35, Anichstr. A-6020 Innsbruck, Austria.
Lichtenberger
C
C
Pechlaner
C
C
Kroesen
G
G
Baubin
M
M
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*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator