title: Hyperfibrinolysis is common in out-of-hospital cardiac arrest: results from a prospective observational thromboelastometry study.
abstract: BACKGROUND
  Cardiocirculatory arrest (CCA) activates procoagulant pathways. It has also been reported to inhibit fibrinolysis, resulting in fibrin deposition and further impairment of blood flow. Until now, no studies have used whole-blood viscoelastic tests to characterize coagulation and the impact of fibrinolysis in out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  Patient with established OHCA who underwent cardiopulmonary resuscitation (CPR) were enrolled. Blood samples were obtained immediately after placement of an intravenous line at the scene, for full blood cell count, standard coagulation tests and rotational thromboelastometric (ROTEM(®)) analyses. Patients with return of spontaneous circulation (ROSC) were compared to non-ROSC patients.
  
  
  RESULTS
  Fifty-three patients (median age 67 years, interquartile range: 56-73 years) were included in the study. ROSC was established in 25 patients. Prothrombin time index (PTI) was significantly lower and activated partial thromboplastin time (aPTT) was significantly prolonged in non-ROSC patients compared to ROSC patients. Clotting time (CT) in the extrinsically activated ROTEM test (EXTEM) was significantly longer in non-ROSC versus ROSC patients. For the remaining EXTEM parameters, there were no significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis (maximum lysis>15% according to ROTEM test results) was observed in 19 patients (35.8%). There was no difference between ROSC and non-ROSC patients in the incidence of hyperfibrinolysis.
  
  
  CONCLUSIONS
  PTI, aPTT and EXTEM CT revealed significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis according to ROTEM test results was much more common than previously assumed. Routine use of fibrinolytic therapy in all patients with prolonged CPR cannot therefore be recommended.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. Herbert.schoechl@auva.at
authors.forename: H
authors.initials: H
authors.lastname: Schöchl
authors.forename: J
authors.initials: J
authors.lastname: Cadamuro
authors.forename: S
authors.initials: S
authors.lastname: Seidl
authors.forename: A
authors.initials: A
authors.lastname: Franz
authors.forename: C
authors.initials: C
authors.lastname: Solomon
authors.forename: C J
authors.initials: CJ
authors.lastname: Schlimp
authors.forename: B
authors.initials: B
authors.lastname: Ziegler
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000628:therapy; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D011517:Prothrombin Time; D020127:Recovery of Function