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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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THE ACUTE CARDIAC PATIENT  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 April;68(4):186-91

language: English

Thrombolytic therapy during cardiopulmonary resuscitation

Snyder-Ramos S. A., Motsch J., Martin E., B. W. Böttiger B. W.

From the Department of Anaesthesiology University of Heidelberg, Heidelberg, Germany


Recent­ly, ­efforts ­have ­been under­tak­en to inves­ti­gate the ­effects of throm­bol­y­sis dur­ing car­di­o­pul­mo­nary resus­ci­ta­tion (CRP) in ­patients suf­fer­ing ­from mas­sive pul­mo­nary embo­lism or ­acute myo­car­dial infarc­tion. In up to 70% of ­patients ­with car­diac ­arrest, one of ­these two dis­eas­es is the under­ly­ing ­cause of dete­ri­ora­tion. Nev­er­the­less, throm­bol­y­sis has not ­been con­duct­ed dur­ing CPR ­because of the ­fear of ­severe bleed­ing com­pli­ca­tions. How­ev­er, an increas­ing num­ber of clin­i­cal stud­ies sug­gest ­that throm­bo­lyt­ic ther­a­py dur­ing CPR can con­trib­ute to hae­mod­y­nam­ic sta­bil­isa­tion and sur­vi­val in ­patients ­with mas­sive pul­mo­nary embo­lism and ­acute myo­car­dial infarc­tion, ­when con­ven­tion­al CPR pro­ce­dures ­have ­been per­formed unsuc­cess­ful­ly. ­Apart ­from the spe­cif­ic cau­sal ­action of throm­bo­lyt­ic ­agents at the ­site of pul­mo­nary embo­li and cor­o­nary throm­bo­sis, experi­men­tal ­data indi­cate ­that throm­bol­y­sis dur­ing CPR can ­improve micro­cir­cu­la­to­ry reper­fu­sion, ­which may be ­most impor­tant in the ­brain. In accor­dance ­with ­these ­data, ­marked acti­va­tion of ­blood coag­u­la­tion with­out ade­quate acti­va­tion of endog­e­nous fib­ri­nol­y­sis has ­been dem­on­strat­ed ear­ly ­after car­diac ­arrest. In sum­mary, throm­bol­y­sis dur­ing CPR is pres­ent­ly a treat­ment strat­e­gy ­that can be per­formed on an indi­vid­u­al ­basis in ­patients ­with pul­mo­nary embo­lism or ­acute myo­car­dial infarc­tion. It may ­become a rou­tine meas­ure if pos­i­tive ­results of ran­dom­ised, con­trolled clin­i­cal ­trials ­will be avail­able in the ­future.

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