Successful use of intra-arrest thrombolysis for electrical storm due to acute myocardial infarction

Acute vascular thrombotic disease, including acutemyocardial 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 circulationwas 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 arrestwith specific attention to the issue of patient selection.