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Titolo:
Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a perspective clinical trial
Autore:
Bottiger, BW; Bode, C; Kern, S; Gries, A; Gust, R; Glatzer, R; Bauer, H; Motsch, J; Martin, E;
Indirizzi:
Univ Heidelberg, Dept Anaesthesiol, D-69120 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69120 , D-69120 Heidelberg, Germany Univ Heidelberg, Dept Internal Med, D-69120 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69120 , D-69120 Heidelberg, Germany Univ Freiburg, Dept Internal Med, D-7800 Freiburg, Germany Univ Freiburg Freiburg Germany D-7800 rnal Med, D-7800 Freiburg, Germany
Titolo Testata:
LANCET
fascicolo: 9268, volume: 357, anno: 2001,
pagine: 1583 - 1585
SICI:
0140-6736(20010519)357:9268<1583:EASOTT>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
HOSPITAL CARDIAC-ARREST; MASSIVE PULMONARY-EMBOLISM; ACUTE MYOCARDIAL-INFARCTION; PLASMINOGEN-ACTIVATOR; UTSTEIN STYLE; BOLUS INJECTION; FIBRINOLYSIS; UROKINASE; AGENTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Bottiger, BW Univ Heidelberg, Dept Anaesthesiol, D-69120 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69120 delberg, Germany
Citazione:
B.W. Bottiger et al., "Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a perspective clinical trial", LANCET, 357(9268), 2001, pp. 1583-1585

Abstract

Background During cardiopulmonary resuscitation (CPR), thrombolysis can help to stabilise patients with pulmonary embolism and myocardial infarction. Moreover, thrombolysis during CPR has beneficial effects on cerebral reperfusion after cardiac arrest. We investigated this new therapeutic approach in patients in whom conventional CPR had been unsuccessful. Methods We assessed, in a prospective study, patients undergoing CPR afterout-of-hospital cardiac arrest for cardiological reasons in whom return ofspontaneous circulation was not achieved within 15 min. According to the Ustein criteria, our control group consisted of patients who were assessed during 1 year. After this year patients were treated with a bolus of 5000 U of heparin and 50mg, over 2 min, of tissue-type plasminogen activator (rt-PA treated group). This intervention was repeated if return of spontaneous circulation was not achieved within the following 30 min. For controls only CPR was given. Findings Overall, 90 patients were included; heparin and rt-PA were given to 40 patients. There were no bleeding complications related to the CPR procedures. Of the rt-PA group, 68% (27) had return of spontaneous circulationand 58% (23) were admitted to a cardiac intensive care unit, compared with44% (22; p=0.026) and 30% (15; p=0.009) of the controls, respectively. At 24 h after cardiac arrest a larger proportion of the rt-PA group than of the controls was alive (35% [14] vs 22% [11], p=0.171), and 15% (six) of rt-PA-treated patients and 8% (four) of controls could be discharged from hospital. Interpretation After initially unsuccessful out-of-hospital CPR, thrombolytic therapy combined with heparin is safe and might improve patient outcome. On the basis of our data a randomised controlled trial might be regarded as ethical.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/01/20 alle ore 18:55:50