title: Successful use of intra-arrest thrombolysis for electrical storm due to acute myocardial infarction.
abstract: Acute vascular thrombotic disease, including acute myocardial infarction and pulmonary embolism, accounts for 70% of sudden outpatient cardiac arrest. The role of intra-arrest thrombolytic administration aimed at reversing the underlying cause of cardiac arrest remains an area of debate with recent guidelines advising against routine use. We present a case of prolonged refractory ventricular fibrillation electrical storm in a patient who demonstrated intra-arrest electrocardiographic and sonographic markers confirming acute myocardial infarction. Return of spontaneous circulation was rapidly achieved after rescue intra-arrest bolus thrombolysis.Highlights of this case are discussed in the context of the current evidence for thrombolytic therapy in cardiac arrest with specific attention to the issue of patient selection.
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
authors: Karina
authors: K
authors: Reyner
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC; Department of Internal Medicine, Division of Critical Care Medicine, Carolinas Medical Center, Charlotte, NC. Electronic address: acheffner@aol.com.
authors: Alan C
authors: AC
authors: Heffner
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
authors: J Lee
authors: JL
authors: Garvey
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
authors: Vivek S
authors: VS
authors: Tayal
mesh_terms: D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology*; D012008:Recurrence; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase