Safety and efficacy of thrombolysis for acute myocardial infarction in patients with prolonged out-of-hospital cardiopulmonary resuscitation

Campen, Linda C.M.C. Van; Leeuwen, Guido R. van; VerBeugt, Freek W.A.

doi:10.1016/0002-9149(94)90137-6

Cited by 60 publications

(25 citation statements)

References 10 publications

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“…In the nonthrombolysis group we observed major bleeding complications in seven of 133 patients (5%, 95% confidence interval 1-9%) (patient nos [14][15][16][17][18][19][20]. In patient 14 (CPR duration 12 min) the X-ray revealed left-sided fluidopneumothorax without signs of tension as major complication.…”

Section: Patients With Major Bleeding Complicationsmentioning

confidence: 89%

“…Scholz et al [17] found no bleeding complications directly related to CPR in 16 patients after successful resuscitation -but in only four of them systemic thrombolysis was performed. Van Campen et al [19] also evaluated the safety of thrombolytic therapy in Values are expressed as n (%) or median (range). F ¼ female; AMI ¼ Acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

“…Only some case reports and small case series provided data regarding the safety and efficacy of systemic thrombolytic treatment in patients who suffered cardiac arrest caused by AMI [13][14][15][16][17][18][19][20]. Some authors consider CPR to be a relative contraindication for thrombolysis, irrespective of the duration of CPR, whilst others consider only prolonged CPR a contraindication.…”

Section: Introductionmentioning

confidence: 99%

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Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment

Kürkciyan¹,

Meron²,

Sterz³

et al. 2003

Journal of Internal Medicine

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Objective. The risk of bleeding complications caused by thrombolysis in patients with cardiac arrest and prolonged cardiopulmonary resuscitation is unclear. We evaluate the complication rate of systemic thrombolysis in patients with out-of-hospital cardiac arrest caused by acute myocardial infarction, especially in relation to duration of cardiopulmonary resuscitation. Design. The study was designed as retrospective cohort study, the risk factor being systemic thrombolysis and the end-point major haemorrhage, defined as life-threatening and/or need for transfusion. Over 10.5 years, emergency cardiac care data, therapy, major haemorrhage and outcome of 265 patients with acute myocardial infarction admitted to an emergency department after successful cardiopulmonary resuscitation were registered. Results. We observed major haemorrhage in 13 of 132 patients who received thrombolysis (10%, 95% confidence interval 5-15%), five of these survived to discharge, none died because of this complication. Major haemorrhage occurred in seven of 133 patients in whom no thrombolytic treatment had been given (5%, 95% confidence interval 1-9%), two of these survived to discharge. Taking into account baseline imbalances between the groups, the risk of bleeding was slightly increased if thrombolytics were used (odds ratio 2.5, 95% confidence interval 0.9-7.4) but this was not significant (P ¼ 0.09). There was no clear association between duration of resuscitation and bleeding complications (z for trend ¼ 1.52, P ¼ 0.12). Survival was not significantly better in patients receiving thrombolysis (odds ratio 1.6, 0.9-3.0, P ¼ 0.12). Conclusions. Bleeding complications after cardiopulmonary resuscitation are frequent, particularly in patients with thrombolytic treatment, but do not appear to be related to the duration of resuscitation. In the light of possible benefits on outcome, thrombolytic treatment should not be withheld in carefully selected patients.

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Section: Patients With Major Bleeding Complicationsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment

Kürkciyan¹,

Meron²,

Sterz³

et al. 2003

Journal of Internal Medicine

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“…Survival of these patients in the field depends above all on the presence of a witness, immediate initiation of bystander cardiopulmonary resuscitation (CPR) and timely electric defibrillation [3, 4]. An important prognostic factor in patients with STEMI is achieving timely reperfusion pharmacologically (thrombolysis) or mechanically by direct percutaneous coronary intervention (PCI) [1, 3, 5, 6]. The hospital mortality of patients with out-of-hospital cardiac arrest (OHCA) and direct PCI (mainly STEMI) ranges between 23 and 46% [7,8,9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Out-of-Hospital Cardiac Arrests in Patients with Acute ST Elevation Myocardial Infarctions in the East Bohemian Region over the Period 2002–2004

et al. 2007

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Background: Early reperfusion by direct percutaneous coronary intervention (PCI) in patients with ST segment elevation acute myocardial infarctions (STEMI) with an out-of-hospital cardiac arrest (OHCA) reduces hospital and longterm mortality. Aims: Evaluating the significance of direct PCI for the short-term (discharge from acute hospitalization) and 1-year survival in patients with acute STEMI after OHCA. Methods: In this prospective study, from April 1, 2002 up to August 31, 2004, a total of 26 hospitalized individuals (22 men, 4 women, aged 35–79 years, median 58.5) from the East Bohemian region with OHCA (primary group of 718 individuals) with acute STEMI were included. Urgent coronary angiography was performed in 20 individuals, and direct PCI was done in 19 of them. The remaining 6 patients did not undergo angiography. Results: Fifteen patients (57.7%) survived acute hospitalization, of whom 11 were without neurological deficits. In the subgroup with urgent coronary angiography 14 patients (70%) survived hospitalization, and in the subgroup without coronarography only 1 patient survived hospitalization (16.7%). In the subgroup with PCIs, 13 out of the 19 patients survived (68.4%). None of the patients died during the 1-year follow-up after being discharged from acute hospitalization. According to the urgent coronarography the artery most commonly responsible for the infarction was the left anterior descending artery (50%). Initial TIMI flow grade 0–I was found in 17 patients and grade II–III in 3 individuals. After PCI, irrespective of stent implantation, an optimal angiographic success (TIMI flow grade II–III) was obtained in 17 cases. Conclusion: Short-term survival of patients after OHCA with STEMI treated with direct PCI was found to be 68.4%. Out of 6 patients not receiving reperfusion therapy 1 survived (16.7%). Over the course of the 1-year follow-up none of the patients died.

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“…O consenso até o momento é de que se a ressuscitação cardiopulmonar foi de curta duração e aparentemente atraumática, o medicamento pode ser administrado. Alguns relatos de administração de trombolíticos na parada cardiorrespiratória após infarto do miocárdio ou embolia pulmonar maciça têm evidenciado resultados animadores, mesmo III Diretriz sobre Tratamento do Infarto Agudo do Miocárdio quando essa terapêutica é utilizada como recurso extremo após falha nas medidas habituais e com ressuscitação prolongada [654][655][656][657][658][659][660][661] . A possível explicação para os efeitos benéficos é que, ao lado de sua ação no processo causal, dissolução do trombo coronariano e/ou de êmbolo arterial pulmonar, haveria incremento da reperfusão na microcirculação, principalmente em território cerebral 662 , como demonstram estudos experimentais 663 , o que permitiria a recuperação com menor dano cerebral.…”

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III Diretriz sobre tratamento do infarto agudo do miocárdio

Avezum¹,

Carvalho²,

Mansur³

et al. 2004

Arq. Bras. Cardiol.

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Classe I: evidência ou concordância geral de que o tratamento é benéfico, útil e eficaz.Classe II: evidência conflitante e/ou divergência de opinião quanto à utilidade e à eficácia do tratamento.Classe IIa: forças das evidências/opiniões em favor da utilidade e da eficácia.Classe IIb: forças das evidências/opiniões menos bem estabelecidas quanto à utilidade e à eficácia.Classe III: evidência ou concordância geral de que o tratamento não é útil/eficaz e em alguns casos pode ser prejudicial. Nível de evidência A: presença de múltiplos estudos clínicos randomizados.Nível de evidência B: presença de um único estudo clínico randomizado ou de estudos não-randomizados.Nível de evidência C: consenso de especialistas.O nível de evidência será apresentado apenas para os tratamentos do infarto do miocárdio, não se aplicando aos procedimentos diagnósticos. Todos os métodos complementares deverão ser realizados por profissionais experientes, segundo as recomendações específicas de cada especialidade.

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Safety and efficacy of thrombolysis for acute myocardial infarction in patients with prolonged out-of-hospital cardiopulmonary resuscitation

Cited by 60 publications

References 10 publications

Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment

Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment

Out-of-Hospital Cardiac Arrests in Patients with Acute ST Elevation Myocardial Infarctions in the East Bohemian Region over the Period 2002–2004

III Diretriz sobre tratamento do infarto agudo do miocárdio

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