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Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction.
Hamera, Joseph A; Bryant, Noah B; Shievitz, Mark S; Berger, David A.
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  • Hamera JA; Department of Emergency Medicine, Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, United States of America.
  • Bryant NB; Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America; Department of Emergency Medicine, Beaumont Hospital-Grosse Pointe, Grosse Pointe, MI, United States of America.
  • Shievitz MS; Department of Emergency Medicine, Henry Ford Medical Center-Fairline, Dearborn, MI, United States of America.
  • Berger DA; Department of Emergency Medicine, Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America; Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America. Electronic address: David.berger@beaumont.edu.
Am J Emerg Med ; 40: 226.e3-226.e5, 2021 02.
Article en En | MEDLINE | ID: mdl-32747160
The empiric usage of systemic thrombolysis for refractory out of hospital cardiac arrest (OHCA) is considered for pulmonary embolism (PE), but not for undifferentiated cardiac etiology [1, 2]. We report a case of successful resuscitation after protracted OHCA with suspected non-PE cardiac etiology, with favorable neurological outcome after empiric administration of systemic thrombolysis. A 47-year-old male presented to the emergency department (ED) after a witnessed OHCA with no bystander cardiopulmonary resuscitation (CPR). His initial rhythm was ventricular fibrillation (VF) which had degenerated into pulseless electrical activity (PEA) by ED arrival. Fifty-seven minutes into his arrest, we gave systemic thrombolysis which obtained return of spontaneous circulation (ROSC). He was transferred to the coronary care unit (CCU) and underwent therapeutic hypothermia. On hospital day (HD) 4 he began following commands and was extubated on HD 5. Subsequent percutaneous coronary intervention (PCI) revealed non-obstructive stenosis in distal LAD. He was discharged home directly from the hospital, with one-month cerebral performance category (CPC) score of one. He was back to work three months post-arrest. Emergency physicians (EP) should be aware of this topic since we are front-line health care professionals for OHCA. Thrombolytics have the advantage of being widely available in ED and therefore offer an option on a case-by-case basis when intra-arrest PCI and ECPR are not available. This case report adds to the existing literature on systemic thrombolysis as salvage therapy for cardiac arrest from an undifferentiated cardiac etiology. The time is now for this treatment to be reevaluated.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Paro Cardíaco Extrahospitalario / Fibrinolíticos / Infarto del Miocardio Límite: Humans / Male / Middle aged Idioma: En Revista: Am J Emerg Med Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Paro Cardíaco Extrahospitalario / Fibrinolíticos / Infarto del Miocardio Límite: Humans / Male / Middle aged Idioma: En Revista: Am J Emerg Med Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos