title: Benefits of thrombolytics in prolonged cardiac arrest and hypothermia over its bleeding risk.
abstract: A 52-year-old non-smoking Caucasian male, who was admitted to our emergency room after he was found unconscious in the bathroom, went into cardiac arrest requiring prolonged cardiopulmonary resuscitation (CPR) and hypothermia therapy. Cardiac catheterization showed non-obstructive coronary arteries and further bedside echocardiogram suggested probable pulmonary embolism (PE) as an underlying cause of cardiac arrest. Although thrombolytic therapy is an effective therapy for PE, it is not routinely given during prolonged CPR for its life- threatening bleeding complications. Many reported cases have suggested a beneficial effect of empiric thrombolytic in cardiac arrest, but unrelated to duration of resuscitation and adjuvant treatments that imposes bleeding risk. We suspect that tissue plasminogen activator (tPA) should be promptly given to prolonged cardiac arrest patients, even when bleeding risk is high with the concurrent hypothermia treatment, keeping the benefits over risk strategy. Our patient received thrombolytic, tPA and showed remarkable clinical, physiological and radiographical improvement.
authors.affiliation: Department of Internal Medicine, Critical Care Medicine and Infectious Disease, St. Luke's Hospital, Chesterfield, Missouri, USA.
authors.forename: Raghav
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Aditi
authors.initials: A
authors.lastname: Jindal
authors.affiliation: Department of Internal Medicine, Critical Care Medicine and Infectious Disease, St. Luke's Hospital, Chesterfield, Missouri, USA.
authors.forename: Hope
authors.initials: H
authors.lastname: Cranston-D'Amato
keywords: Hypothermia; prolonged cardiac arrest; thrombolytics
references.citation: Herz. 2012 Sep;37(6):675-86; quiz 687-9
references.pmid: 22836902
references.citation: Am J Emerg Med. 2013 Jan;31(1):266.e1-3
references.pmid: 22742949
references.citation: Am J Emerg Med. 2013 Jun;31(6):974-7
references.pmid: 23541172
references.citation: MMWR Morb Mortal Wkly Rep. 2002 Feb 15;51(6):123-6
references.pmid: 11898927
references.citation: Cochrane Database Syst Rev. 2012 Sep 12;(9):CD004128
references.pmid: 22972067
references.citation: J Am Coll Cardiol. 2000 Nov 1;36(5):1632-6
references.pmid: 11079669
references.citation: Am J Cardiol. 1991 Nov 15;68(13):1388-92
references.pmid: 1951130
references.citation: Ann Pharmacother. 2010 Dec;44(12):2007-13
references.pmid: 21119096
references.citation: Case Rep Emerg Med. 2012;2012:794019
references.pmid: 23326723
references.citation: Am J Emerg Med. 2013 Feb;31(2):453.e1-3
references.pmid: 22980371
references.citation: Acta Anaesthesiol Scand. 2009 Aug;53(7):926-34
references.pmid: 19549271
references.citation: Arch Intern Med. 2000 May 22;160(10):1529-35
references.pmid: 10826469
references.citation: Circulation. 2001 Oct 30;104(18):2158-63
references.pmid: 11684624
references.citation: Anaesth Intensive Care. 1994 Dec;22(6):647-58
references.pmid: 7892967