Skip to main content
SpringerLink
Log in

Vorgehen bei STEMI/NSTEMI nach Reanimation

Strategies of reperfusion after successful cardiopulmonary resuscitation of patients with myocardial infarction

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Therapie eines Myokardinfarktes mit ST-Streckenhebungen (STEMI) nach Kreislaufstillstand mit primär erfolgreicher Reanimation ist nicht klar etabliert. Es gibt die Option des konservativen Abwartens, der systemischen Thrombolyse und der primären perkutanen koronaren Intervention (PPCI). Welches der Therapiekonzepte das beste Langzeitergebnis hervorbringt, ist bislang unklar. In der vorliegenden Arbeit werden bisherige Berichte analysiert. Es werden das gesamte Überleben einerseits und neurologisch intaktes Überleben andererseits sowie Komplikationen (z. B. Blutungen) evaluiert.

Ergebnisse

Als Resultat zeigt sich eine höhere Rate an Überleben bei der PPCI (61%) im Vergleich zur Thrombolyse (54%). Das neurologisch intakte Langzeitüberleben (>6 Monate mit Cerebral Performance Category 1 oder 2) ist bei der Thrombolyse mit 54% besser als bei der PPCI (49%). Die konservative Therapie ohne Rekanalisation ist in beiden Aspekten schlechter (40% bzw 37%). Blutungen spielen keine relevante Rolle und verschlechtern nicht das Überleben, auch wenn therapeutische Hypothermie eingesetzt wird.

Schlussfolgerungen

Systemische Thrombolyse bei Patienten nach erfolgreicher Reanimation bei STEMI führt zu einer höheren Rate von Patienten mit neurologisch intaktem Überleben verglichen mit PPCI bzw. mit konservativer Therapie ohne Reperfusion.

Abstract

Background

Treatment of myocardial infarction with ST-elevation after successful resuscitation from cardiac arrest is not clearly established. There are three options: no immediate reperfusion, systemic thrombolysis or primary percutaneous coronary intervention (PPCI). In the present review the published data on outcome, neurologically intact survival and complications (e.g. bleeding) were analysed.

Results

The results showed that survival was better with PPCI (61%) compared to thrombolysis (54%) or no reperfusion (40%). Neurologically intact long term survival (>6 months with cerebral performance category 1 or 2) was found more often in thrombolysed patients (54%) than in patients with PPCI (49%) or without reperfusion therapy (37%). Bleeding complications have no relevant influence on outcome, even if therapeutic hypothermia is applied.

Conclusions

Systemic thrombolysis after successful cardiopulmonary resuscitation of myocardial infarction with ST-elevation leads to a better rate neurologically intact patient survival compared to primary coronary intervention or to conservative treatment without reperfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arntz HR, Wenzel V, Dissmann R et al. (2008) Out-of-hospital thrombolysis during cardiopulmonary resuscitation in patients with high likelihood of ST-elevation myocardial infarction. Resuscitation 76: 180–184

    Article  PubMed  Google Scholar 

  2. Böttiger BW, Motsch J, Bohrer H et al. (1995) Activation of blood coagulation after cardiac arrest is not balanced adequately by activation of endogenous fibrinolysis. Circulation 92: 2572–2578

    PubMed  Google Scholar 

  3. Bulut S, Aengevaeren WR, Luijten HJ et al. (2000) Successful out-of-hospital cardiopulmonary resuscitation: what is the optimal in-hospital treatment strategy? Resuscitation 47: 155–161

    Article  PubMed  CAS  Google Scholar 

  4. Cross SJ, Shiang HS, Rawles JM et al. (1991) Safety of thrombolysis in association with cardiopulmonary resuscitation. BMJ 303: 1242–1242

    Article  PubMed  CAS  Google Scholar 

  5. de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI et al. (1998) Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors. Heart 79: 356–361

    Google Scholar 

  6. Fischer M, Bottiger BW, Popov-Cenic S et al. (1996) Thrombolysis using plasminogen activator and heparin reduces cerebral no-reflow after resuscitation from cardiac arrest: an experimental study in the cat. Intensive Care Med 22: 1214–1223

    Article  PubMed  CAS  Google Scholar 

  7. Gando S, Nanzaki S, Morimoto Y et al. (1999) Alterations of soluble L- and P-selectins during cardiac arrest and CPR. Intensive Care Med 25: 588–593

    Article  PubMed  CAS  Google Scholar 

  8. Garot P, Lefevre T, Eltchaninoff H et al. (2007) Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation 115: 1354–1362

    Article  PubMed  Google Scholar 

  9. Gorjup V, Radsel P, Kocjancic ST et al. (2007) Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation. Resuscitation 72: 379–385

    Article  PubMed  Google Scholar 

  10. Gunnar RM, Passamani ER, Bourdillon PD et al. (1990) Guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (Subcommittee to develop guidelines for the early management of patients with acute myocardial infarction). J Am Coll Cardiol 16: 249–292

    Article  PubMed  CAS  Google Scholar 

  11. Hossmann KA (1993) Ischemia-mediated neuronal injury. Resuscitation 26: 225–235

    Article  PubMed  CAS  Google Scholar 

  12. Hovdenes J, Laake JH, Aaberge L et al. (2007) Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 51: 137–142

    Article  PubMed  CAS  Google Scholar 

  13. Huber K, De CR, Kristensen SD et al. (2005) Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction. Eur Heart J 26: 2063–2074

    Article  PubMed  Google Scholar 

  14. Janata K, Holzer M, Kurkciyan I et al. (2003) Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism. Resuscitation 57: 49–55

    Article  PubMed  Google Scholar 

  15. Kalla K, Christ G, Karnik R et al. (2006) Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 113: 2398–2405

    Article  PubMed  Google Scholar 

  16. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361: 13–20

    Article  PubMed  Google Scholar 

  17. Keuper W, Dieker HJ, Brouwer MA et al. (2007) Reperfusion therapy in out-of-hospital cardiac arrest: current insights. Resuscitation 73: 189–201

    Article  PubMed  Google Scholar 

  18. Knafelj R, Radsel P, Ploj T et al. (2007) Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction. Resuscitation 74: 227–234

    Article  PubMed  Google Scholar 

  19. Kürkciyan I, Meron G, Sterz F et al. (2003) Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment. J Intern Med 253: 128–135

    Article  PubMed  Google Scholar 

  20. Lederer W, Lichtenberger C, Pechlaner C et al. (2001) Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest. Resuscitation 50: 71–76

    Article  PubMed  CAS  Google Scholar 

  21. Markusohn E, Roguin A, Sebbag A et al. (2007) Primary percutaneous coronary intervention after out-of-hospital cardiac arrest: patients and outcomes. Isr Med Assoc J 9: 257–259

    PubMed  Google Scholar 

  22. Muller D, Agrawal R, Arntz HR (2006) How sudden is sudden cardiac death? Circulation 114: 1146–1150

    Article  PubMed  Google Scholar 

  23. Peels HO, Jessurun GA, van dHI et al. (2008) Outcome in transferred and nontransferred patients after primary percutaneous coronary intervention for ischaemic out-of-hospital cardiac arrest. Catheter Cardiovasc Interv 71: 147–151

    Article  PubMed  Google Scholar 

  24. Quintero-Moran B, Moreno R, Villarreal S et al. (2006) Percutaneous coronary intervention for cardiac arrest secondary to ST-elevation acute myocardial infarction. Influence of immediate paramedical/medical assistance on clinical outcome. J Invasive Cardiol 18: 269–272

    PubMed  Google Scholar 

  25. Richling N, Herkner H, Holzer M et al. (2007) Thrombolytic therapy vs primary percutaneous intervention after ventricular fibrillation cardiac arrest due to acute ST-segment elevation myocardial infarction and its effect on outcome. Am J Emerg Med 25: 545–550

    Article  PubMed  Google Scholar 

  26. Ruiz-Bailen M, guayo de HE, Serrano-Corcoles MC et al. (2001) Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation. Intensive Care Med 27: 1050–1057

    Article  PubMed  CAS  Google Scholar 

  27. Schefold JC, Storm C, Joerres A et al. (2008) Mild therapeutic hypothermia after cardiac arrest and the risk of bleeding in patients with acute myocardial infarction. Int J Cardiol. Epub ahead of print

  28. Schiele R, Rustige J, Burczyk U et al. (1996) Thrombolysis after resuscitation in acute myocardial infarction. J Am Coll Cardiol 27 (Suppl. 1): 279A

    Google Scholar 

  29. Scholz KH, Tebbe U, Herrmann C et al. (1992) Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 69: 724–728

    Article  PubMed  CAS  Google Scholar 

  30. Schreiber W, Gabriel D, Sterz F et al. (2002) Thrombolytic therapy after cardiac arrest and its effect on neurological outcome. Resuscitation 52: 63–69

    Article  PubMed  CAS  Google Scholar 

  31. Sherry S, Bell WR, Duckert FH et al. (1980) Thrombolytic therapy in thrombosis: a National Institutes of Health consensus development conference. Ann Intern Med 93: 141–144

    Google Scholar 

  32. Silber S, Albertsson P, Aviles FF et al. (2005) Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European society of cardiology. Eur Heart J 26: 804–847

    Article  PubMed  Google Scholar 

  33. Silber S, Albertsson P, Aviles FF et al. (2005) Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European society of cardiology. Eur Heart J 26: 804–847

    Article  PubMed  Google Scholar 

  34. Spaulding CM, Joly LM, Rosenberg A et al. (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336: 1629–1633

    Article  PubMed  CAS  Google Scholar 

  35. Spaulding CM, Joly LM, Rosenberg A et al. (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336: 1629–1633

    Article  PubMed  CAS  Google Scholar 

  36. Spaulding CM, Laurent I, Monchi M et al. (2006) Outcomes after cardiopulmonary resuscitation. J Am Coll Cardiol 164A

  37. Steg PG, Bonnefoy E, Chabaud S et al. (2003) Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 108: 2851–2856

    Article  PubMed  Google Scholar 

  38. Stenestrand U, Lindback J, Wallentin L (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296: 1749–1756

    Article  PubMed  CAS  Google Scholar 

  39. Stewart BF, Weaver WD, Parsons LS et al. (1996) Reperfusion therapy after pre-hospital cardiac arrest and its influence on outcome after acute myocardial infarction. J Am Coll Cardiol 27(Suppl 1): 278A–

    Article  Google Scholar 

  40. Tenaglia AN, Califf RM, Candela RJ et al. (1991) Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. Am J Cardiol 68: 1015–1019

    Article  PubMed  CAS  Google Scholar 

  41. van Campen LC, van Leeuwen GR, Verheugt FW (1994) Safety and efficacy of thrombolysis for acute myocardial infarction in patients with prolonged out-of-hospital cardiopulmonary resuscitation. Am J Cardiol 73: 953–955

    Article  Google Scholar 

  42. Voipio V, Kuisma M, Alaspaa A et al. (2001) Thrombolytic treatment of acute myocardial infarction after out-of-hospital cardiac arrest. Resuscitation 49: 251–258

    Article  PubMed  CAS  Google Scholar 

  43. Weston CF, Avery P (1992) Thrombolysis following pre-hospital cardiopulmonary resuscitation. Int J Cardiol 37: 195–198

    Article  PubMed  CAS  Google Scholar 

  44. Widimsky P, Budesinsky T, Vorac D et al. (2003) Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial-PRAGUE-2. Eur Heart J 24: 94–104

    Article  PubMed  CAS  Google Scholar 

  45. Wolfrum S, Pierau C, Radke PW et al. (2008) Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med 36: 1780–1786

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt vorliegt.

Author information

Authors and Affiliations

  1. Univ. Klinik für Notfallmedizin, Medizinische Universität Wien – Allgemeines Krankenhaus, Währinger Gürtel 18-20 / 6D, A-1090, Wien, Österreich

    P. Eisenburger

Authors
  1. P. Eisenburger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Eisenburger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eisenburger, P. Vorgehen bei STEMI/NSTEMI nach Reanimation. Notfall Rettungsmed 11, 447–452 (2008). https://doi.org/10.1007/s10049-008-1069-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-008-1069-x

Schlüsselwörter

Keywords

Search

Navigation