Out-of-hospital thrombolysis during cardiopulmonary resuscitation in patients with high likelihood of ST-elevation myocardial infarction

被引:36
作者
Arntz, Hans-Richard [1 ]
Wenzel, Volker [4 ]
Dissmann, Ruediger [3 ]
Marschalk, Angela [1 ]
Breckwoldt, Jan [2 ]
Mueller, Dirk [1 ]
机构
[1] Benjamin Franklin Med Ctr, Dept Med, Div Cardiol Plumonol, Charite, Berlin, Germany
[2] Benjamin Franklin Med Ctr, Dept Anesthesiol & Crit Care Med, Charite, Berlin, Germany
[3] Krankenhaus Reinkenheide, Dept Cardiol, Bremerhaven, Germany
[4] Innsbruck Med Univ, Dept Anesthesiol & Crit Care Med, Innsbruck, Austria
关键词
cardiopulmonary resuscitation; thrombolysis; myocardial infarction;
D O I
10.1016/j.resuscitation.2007.07.012
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Up to 90% of cardiac arrests are due to acute myocardial infarction or severe myocardial ischaemia. Thrombolysis is an effective treatment for ST-elevation myocardial infarction (STEMI), but there is no evidence or guideline to put forward a thrombolysis strategy during cardiopulmonary resuscitation (CPR). In two physician-manned emergency medical service (EMS) units in Bertin, Germany, using thrombolysis is based on an individual judgment of the EMS physician managing the CPR attempt. In this retrospective analysis over 3 years (total 22.164 scene calls), thrombolysis was started at the scene in 50 patients during brief intermittent phases of spontaneous circulation, and in 3 patients during ongoing CPR. On-scene diagnosis of myocardial infarction was established in 45 patients (85%) by a 12-lead ECG, 5 (9%) patients had a left bundle branch block. Sixteen patients (30%) died at the scene, 37 patients (70%) were admitted to a hospital. Inhospital, mortality was 35% (13 of 37 patients), with cause of death being cardiogenic shock in nine patients, hypoxic cerebral coma in two and acute haemorrhage in two other patients. All 24 of 53 (45%) survivors were discharged with an excellent neurological recovery. CPR was started by an EMS physician in 18 of the 24 survivals (75%) and emergency medical technicians who arrived first in six (25%). Duration of CPR until return of spontaneous circulation was < 10 min in 13 of 24 (54%) of the survivors. Thrombolysis was initiated during intermittent phases of spontaneous circulation in 50 (94%) of all patients and in 23 (96%) of the 24 survivors. In conclusion, this retrospective analysis shows excellent survival rates and neurological outcome in selected patients with a high likelihood of myocardial infarction, who develop cardiac arrest and are treated with thrombolysis. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:180 / 184
页数:5
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