title: Impact of fibrinolysis on immediate prognosis of patients with out-of-hospital cardiac arrest.
abstract: Fibrinolytic therapy (FT) during out-of-hospital cardiac arrest (OHCA) has been studied in several trials, but they have produced unsatisfactory results even in the most recent Thrombolysis in Cardiac Arrest (TROICA) study. This study aimed to assess the impact of FT provided by an out-of-hospital emergency physician on the immediate prognosis of patients with OHCA. We performed a retrospective study in which the primary endpoint was survival to hospital admission. Among 5,102 patients with OHCA in Paris and the suburban area who received medical care from the Fire Brigade of Paris, 1,261 met the following inclusion criteria: age above 18 years with non-traumatic OHCA. Among 107 patients who received FT, 51 (47.7%) survived to hospital admission whereas 272 out of 1,154 (23.6%) patients who did not receive FT survived to hospital admission. A matching process based on a propensity score used to equalise potential prognosis factors in both groups demonstrated that FT was associated with more frequent survival to hospital admission (OR adjusted: 1.7; CI 95% [1.09-2.68]). This result was observed particularly in patients who were not initially shocked by automatic electrical defibrillator (AED) (OR(a) = 3.61; CI 95% [1.88-6.96]). This study showed that fibrinolysis was associated with improved survival to hospital admission, after performing a propensity analysis. FT may be beneficial in out-of-hospital arrest patients. However, any conclusions drawn are limited by the retrospective nature of the study.
authors.affiliation: Service Médical de la Brigade de Sapeurs Pompiers de Paris, 1 Place Jules Renard, 75017 Paris, France. aurelien.renard211@orange.fr
authors.forename: Aurélien
authors.initials: A
authors.lastname: Renard
authors.forename: Catherine
authors.initials: C
authors.lastname: Verret
authors.forename: Daniel
authors.initials: D
authors.lastname: Jost
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Meynard
authors.forename: Julie
authors.initials: J
authors.lastname: Tricehreau
authors.forename: Olivier
authors.initials: O
authors.lastname: Hersan
authors.forename: David
authors.initials: D
authors.lastname: Fontaine
authors.forename: Frédérique
authors.initials: F
authors.lastname: Briche
authors.forename: Patrick
authors.initials: P
authors.lastname: Benner
authors.forename: Olivier
authors.initials: O
authors.lastname: de Stabenrath
authors.forename: Christophe
authors.initials: C
authors.lastname: Bartou
authors.forename: Nicolas
authors.initials: N
authors.lastname: Segal
authors.forename: Laurent
authors.initials: L
authors.lastname: Domanski
mesh_terms: D000368:Aged; D005260:Female; D005342:Fibrinolysis; D006323:Heart Arrest; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D010297:Paris; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy