title: Out-of-hospital thrombolysis during cardiopulmonary resuscitation in patients with high likelihood of ST-elevation myocardial infarction.
abstract: Up to 90% of cardiac arrests are due to acute myocardial infarction or severe myocardial ischaemia. Thrombolysis is an effective treatment for ST-elevation myocardial infarction (STEMI), but there is no evidence or guideline to put forward a thrombolysis strategy during cardiopulmonary resuscitation (CPR). In two physician-manned emergency medical service (EMS) units in Berlin, Germany, using thrombolysis is based on an individual judgment of the EMS physician managing the CPR attempt. In this retrospective analysis over 3 years (total 22.164 scene calls), thrombolysis was started at the scene in 50 patients during brief intermittent phases of spontaneous circulation, and in 3 patients during ongoing CPR. On-scene diagnosis of myocardial infarction was established in 45 patients (85%) by a 12-lead ECG, 5 (9%) patients had a left bundle branch block. Sixteen patients (30%) died at the scene, 37 patients (70%) were admitted to a hospital. In-hospital mortality was 35% (13 of 37 patients), with cause of death being cardiogenic shock in nine patients, hypoxic cerebral coma in two and acute haemorrhage in two other patients. All 24 of 53 (45%) survivors were discharged with an excellent neurological recovery. CPR was started by an EMS physician in 18 of the 24 survivals (75%) and emergency medical technicians who arrived first in six (25%). Duration of CPR until return of spontaneous circulation was <10 min in 13 of 24 (54%) of the survivors. Thrombolysis was initiated during intermittent phases of spontaneous circulation in 50 (94%) of all patients and in 23 (96%) of the 24 survivors. In conclusion, this retrospective analysis shows excellent survival rates and neurological outcome in selected patients with a high likelihood of myocardial infarction, who develop cardiac arrest and are treated with thrombolysis.
authors.affiliation: Department of Medicine, Division of Cardiology/Pulmonology, Benjamin Franklin Medical Center, Charité, Berlin, Germany. hans-richard.arntz@charite.de
authors.forename: Hans-Richard
authors.initials: HR
authors.lastname: Arntz
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Dissmann
authors.forename: Angela
authors.initials: A
authors.lastname: Marschalk
authors.forename: Jan
authors.initials: J
authors.lastname: Breckwoldt
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
mesh_terms: D001241:Aspirin / Q000008:administration & dosage; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010045:Outpatients; D012189:Retrospective Studies; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage*; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase; D001241:Aspirin