Tissue Plasminogen Activator in Cardiac Arrest with Pulseless Electrical Activity

Abu‐Laban, Riyad B.; Christenson, James M.; Innes, Grant; Beek, Catherina A. van; Wanger, Karen; McKnight, R. Douglas; MacPhail, Iain; Puskaric, Joe; Sadowski, Richard; Singer, Joel; Schechter, Martin T.; Wood, Victor

doi:10.1056/nejmoa012885

Cited by 171 publications

(52 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is mainly based on the difficult clinical diagnosis of PE in the emergency settings [9], [15]. Given that reliable clinical diagnostic criteria are lacking [16], [17], a recent thrombolysis study in out-of-hospital resuscitation did not show an overall benefit in a population of patients with presumed low incidence of PE of 6% [11].…”

Section: Discussionmentioning

confidence: 99%

Impact of Rescue-Thrombolysis during Cardiopulmonary Resuscitation in Patients with Pulmonary Embolism

Nia

Gassanov

et al. 2009

PLoS ONE

View full text Add to dashboard Cite

BackgroundCardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE.Methodology/Principal FindingsWe analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.6±1.2 min versus 24.6±0.8 min; p<0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.0±1.3 vs. 22.5±0.9 min; p<0.001).ConclusionRescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of Rescue-Thrombolysis during Cardiopulmonary Resuscitation in Patients with Pulmonary Embolism

Nia

Gassanov

et al. 2009

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…2 It is impossible to know if the thrombolytic agent played a role in our patient's outcome; however, two randomized controlled trials have shown that thrombolysis during CPR is not beneficial in an undifferentiated population. 3,4 What is noteworthy about our case is the use of ECMO and the probable role it played. Given his profound cardiogenic shock and respiratory failure despite percutaneous coronary intervention, inotropic support, and the use of IABP, it is virtually certain that our patient would have died without ECMO.…”

Section: Discussionmentioning

confidence: 82%

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Abu‐Laban

Migneault

Grant

et al. 2015

CJEM

Self Cite

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed. RÉ SUMÉL'oxygé nation extracorporelle sur oxygé nateur à membrane (OEOM) est un moyen de fournir une assistance cardiaque et respiratoire temporaire à des patients gravement malades. Le rô le de l'OEOM a gagné du terrain chez certains adultes aux services des urgences (SU) au cours des derniè res anné es. Sera exposé ici le cas spectaculaire d'un homme de 29 ans, soumis à l'OEOM veino-arté rielle pour un choc cardiogé nique et une insuffisance respiratoire suivant un collapsus et un arrê t cardiaque causé par un accè s prolongé de fibrillation ventriculaire, qui est survenu au SU de l'hô pital. Les moyens de ré animation mis en oeuvre avant le dé but de l'OEOM comprenaient des manoeuvres de ré animation cardiorespiratoire (RCR) pratiqué es de faç on quasi continue durant 49 minutes; 11 tentatives de dé fibrillation; l'administration de nombreux mé dicaments, dont un thrombolytique, pendant que se poursuivaient les manoeuvres de RCR; une intervention coronarienne percutané e et la pose d'une endoprothè se pour une dissection du segment moyen de l'artè re interventriculaire anté rieure et une oblité ration thrombotique; un soutien inotrope et la contrepulsion par ballon intra-aortique. Au cours des 48 heures suivant le dé but de l'OEOM, l'é tat cardiorespiratoire du patient s'est amé lioré rapidement, et celui-ci est retourné chez lui 9 jours aprè s son admission, et ce, sans souffrir de sé quelles neurologiques. Seront passé s en revue l'historique, les indications et le rô le de plus en plus grand de l'OEOM dans diverses affections, dont l'arrê t cardiaque.

show abstract

“…Previous reports using thrombolytic agents such as tissue plasminogen activator (t-PA) showed thrombolysis therapy during cardiac resuscitation was related to higher ROSC ratio compared with control [8, 10, 12]. However, the randomized control trial on the effectiveness of t-PA for 233 cardiac arrest patients with pulseless electric activities demonstrated fibrinolysis therapy did not improve the percentage of ROSC or clinical outcomes [5]. A meta-analysis in 2006 concluded that thrombolytic therapy was related to 2.5 times as many ROSC cases compared to control, although there were significantly more cases of severe bleeding in the thrombolytic group [7].…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that fibrin clot formation induced by activated extrinsic coagulation pathway and/or hyperfibrinolysis with systemic hypoperfusion are observed in patients with OHCA [3, 4]. However, antithrombotic treatment for patient with OHCA has been controversial [5–12]. …”

Section: Introductionmentioning

confidence: 99%

Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

et al. 2017

View full text Add to dashboard Cite

It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study. We divided patients into two groups based on the presence or absence of ROSC, and performed statistical analysis utilizing patient characteristics, prehospital data, laboratory data, and ROTEM data. Seventy-five patients were enrolled. The ROSC group and non-ROSC group included 23 and 52 patients, respectively. The logistic regression analysis, utilizing significant parameters by univariate analysis, demonstrated that lactate level [odds ratio (OR) 0.880, 95% confidence interval (CI) 0.785–0.986, p = 0.028] and A30 of EXTEM test [OR 1.039, 95% CI 1.010–1.070, p = 0.009] were independent risk factors for ROSC. The cut-off values of lactate and A30 in EXTEM were 12.0 mmol/L and A 48.0 mm, respectively. We defined a positive prediction for ROSC if the patient presented lower lactate level (<12.0 mmol/L) and higher A30 of EXTEM (≥48.0 mm) with high specificity (94.7%) and accuracy (75.0%). The present study showed that lactate level and ROTEM parameter of clot firmness were reliable predictors of ROSC in the ED for adult patients with OHCA.

show abstract

Tissue Plasminogen Activator in Cardiac Arrest with Pulseless Electrical Activity

Cited by 171 publications

References 40 publications

Impact of Rescue-Thrombolysis during Cardiopulmonary Resuscitation in Patients with Pulmonary Embolism

Impact of Rescue-Thrombolysis during Cardiopulmonary Resuscitation in Patients with Pulmonary Embolism

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

Contact Info

Product

Resources

About