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Thrombolysis During Cardiopulmonary Resuscitation in Patients with Acute Pulmonary Embolism

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Venous Thromboembolism

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Conclusion

Thrombolysis during CPR in patients after massive PE may be an adequate therapeutic option to improve overall and neurological outcome of this group of patients with a very poor prognosis. Thrombolytic drugs appear to have beneficial effects by both direct action on pulmonary emboli and improvement of microcirculatory perfusion. Clinical studies provide increasing evidence that thrombolytic therapy during CPR can contribute to a stabilization in patients with cardiac arrest caused by acute MI or massive PE. In addition, an improvement in the microcirculatory perfusion caused by thrombolytic treatment of patients with cardiac arrest may be a major reason for an improved neurological outcome.

Thrombolysis during CPR may increase the incidence of bleeding events, but currently available data suggest that these potential risks probably do not outweigh the benefits provided by thrombolysis during cardiac arrest. Regarding the poor prognosis of cardiac arrest and the urgent need for causal treatment options, it is now necessary to assess the effects and potential risks of this promising treatment in a large, randomized clinical trial.

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References

  1. Silfvast T. Cause of death in unsuccessful prehospital resuscitation. J Intern Med 1991;229(4):331–5.

    CAS  PubMed  Google Scholar 

  2. Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997;336(23):1629–33.

    Article  CAS  PubMed  Google Scholar 

  3. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998;98(21):2334–51.

    CAS  PubMed  Google Scholar 

  4. Kürkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160(10):1529–35.

    PubMed  Google Scholar 

  5. Böttiger BW, Bach A, Böhrer H, et al. Acute thromboembolism of the lung. Clinical picture-pathophysiology-diagnosis-therapy. Anaesthesist 1993;42(2):55–73.

    PubMed  Google Scholar 

  6. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995;108(4):978–81.

    CAS  PubMed  Google Scholar 

  7. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121(3):877–905.

    Article  PubMed  Google Scholar 

  8. Böttiger BW, Böhrer H, Bach A, et al. Bolus injection of thrombolytic agents during cardiopulmonary resuscitation for massive pulmonary embolism. Resuscitation 1994;28(1):45–54.

    PubMed  Google Scholar 

  9. Newman DH, Greenwald I, Callaway CW. Cardiac arrest and the role of thrombolytic agents. Ann Emerg Med 2000;35(5):472–80.

    Article  CAS  PubMed  Google Scholar 

  10. Spöhr F, Böttiger BW. Safety of thrombolysis during cardiopulmonary resuscitation. Drug Saf 2003;26(6):367–79.

    PubMed  Google Scholar 

  11. Acute myocardial infarction: pre-hospital and in-hospital management. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 1996;17(1):43–63.

    Google Scholar 

  12. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1999;100(9):1016–30.

    CAS  PubMed  Google Scholar 

  13. Padosch SA, Motsch J, Böttiger BW. Thrombolysis during cardiopulmonary resuscitation. Anaesthesist 2002;51:516–32.

    Article  CAS  PubMed  Google Scholar 

  14. Hossmann KA. Ischemia-mediated neuronal injury. Resuscitation 1993;26(3):225–35.

    Article  CAS  PubMed  Google Scholar 

  15. Gando S, Nanzaki S, Morimoto Y, et al. Out-of-hospital cardiac arrest increases soluble vascular endothelial adhesion molecules and neutrophil elastase associated with endothelial injury. Intensive Care Med 2000;26(1):38–44.

    Article  CAS  PubMed  Google Scholar 

  16. Böttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest. Curr Opin Crit Care 2001;7(3):176–83.

    PubMed  Google Scholar 

  17. Fischer M, Böttiger BW, Popov-Cenic S, et al. Thrombolysis using plasminogen activator and heparin reduces cerebral no-reflow after resuscitation from cardiac arrest: an experimental study in the cat. Intensive Care Med 1996;22(11):1214–23.

    CAS  PubMed  Google Scholar 

  18. Mossakowski MJ, Lossinsky AS, Pluta R, et al. Abnormalities of the blood-brain barrier in global cerebral ischemia in rats due to experimental cardiac arrest. Acta Neurochir Suppl (Wien) 1994;60:274–6.

    CAS  Google Scholar 

  19. Böttiger BW, Motsch J, Böhrer H, et al. Activation of blood coagulation after cardiac arrest is not balanced adequately by activation of endogenous fibrinolysis. Circulation 1995;92(9):2572–8.

    PubMed  Google Scholar 

  20. Gando S, Kameue T, Nanzaki S, et al. Massive fibrin formation with consecutive impairment of fibrinolysis in patients with out-of-hospital cardiac arrest. Thromb Haemostasis 1997;77:278–82.

    CAS  Google Scholar 

  21. Böttiger BW, Böhrer H, Böker T, et al. Platelet Factor 4 release in patients undergoing cardiopulmonary resuscitation: can reperfusion be impaired by platelet aggregation? Acta Anaesthesiol Scand 1996;40:631–5.

    PubMed  Google Scholar 

  22. Gando S, Kameue T, Nanzaki S, et al. Platelet activation with massive formation of thromboxane A2 during and after cardiopulmonary resuscitation. Intensive Care Med 1997;23(1):71–6.

    Article  CAS  PubMed  Google Scholar 

  23. Renkes-Hegendörfer U, Herrmann K. Successful treatment of a case of fulminant massive pulmonary embolism with streptokinase. Anaesthesist 1974;23:500–1.

    PubMed  Google Scholar 

  24. Köhle W, Pindur G, Stauch M, et al. Hochdosierte Streptokinasetherapie bei fulminanter Lungenarterienembolie. Anaesthesist 1984;33:469.

    Google Scholar 

  25. Scholz KH, Hilmer T, Schuster S, et al. Thrombolysis in resuscitated patients with pulmonary embolism. Dtsch Med Wochenschr 1990;115(24):930–5.

    CAS  PubMed  Google Scholar 

  26. Bedell SE, Delbanco TL, Cook EF, et al. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983;309(10):569–76.

    CAS  PubMed  Google Scholar 

  27. Ballew KA, Philbrick JT, Caven DE, et al. Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target. Arch Intern Med 1994;154(21):2426–32.

    Article  CAS  PubMed  Google Scholar 

  28. Bedell SE, Fulton EJ. Unexpected findings and complications at autopsy after cardiopulmonary resuscitation (CPR). Arch Intern Med 1986;146(9):1725–8.

    Article  CAS  PubMed  Google Scholar 

  29. Böttiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet 2001;357(9268):1583–5.

    PubMed  Google Scholar 

  30. Klefisch F, Gareis R, Störk T, et al. Präklinische ultima-ratio Thrombolyse bei therapierefraktärer kardiopulmonaler Reanimation. Intensivmedizin 1995;32:155–62.

    Google Scholar 

  31. Lederer W, Lichtenberger C, Pechlaner C, et al. Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest. Resuscitation 2001;50(1):71–6.

    Article  CAS  PubMed  Google Scholar 

  32. Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 2002;346(20):1522–8.

    Article  CAS  PubMed  Google Scholar 

  33. Böttiger BW, Padosch SA, Wenzel V, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 2002;17347(16):1281–2.

    Google Scholar 

  34. Horstkotte D, Heintzen M, Strauer B. Combined mechanical and thrombolytic reopening of the lung-stream-track with massive lung-arterial-embolism. Intensivmedizin 1990;27:124–32.

    Google Scholar 

  35. Hopf H, Grote B, Becker H, et al. Erfolgreiche Lysetherapie einer perioperativ aufgetretenen, reanimationsbedürftigen Lungenembolie mit rekombiniertem Gewebeplasminogenaktivator (rt-PA). Anaesthesist 1990;39:50–2.

    CAS  PubMed  Google Scholar 

  36. Krischer JP, Fine EG, Davis JH, et al. Complications of cardiac resuscitation. Chest 1987;92(2):287–91.

    CAS  PubMed  Google Scholar 

  37. Nagel EL, Fine EG, Krischer JP, et al. Complications of CPR. Crit Care Med 1981;9(5):424.

    CAS  PubMed  Google Scholar 

  38. Powner DJ, Holcombe PA, Mello LA. Cardiopulmonary resuscitation-related injuries. Crit Care Med 1984;12(1):54–5.

    CAS  PubMed  Google Scholar 

  39. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Lancet 1994;343(8893):311–22.

    Google Scholar 

  40. Kanter DS, Mikkola KM, Patel SR, et al. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest 1997;111(5):1241–5.

    CAS  PubMed  Google Scholar 

  41. Siebenlist D, Gattenlöhner W. Fibrinolysis with rt-PA for fulminant pulmonary thromboembolism. Intensivmedizin 1990;27:302–5.

    Google Scholar 

  42. Böttiger BW, Reim SM, Diezel G. Successful treatment of a fulminant pulmonary embolism using a high-dose bolus injection of urokinase during cardiopulmonary resuscitation. Anasthesiol Intensivmed Notfallmed Schmerzther 1991;26(1):29–36.

    PubMed  Google Scholar 

  43. Hopf HB, Flossdorf T, Breulmann M. Rekombinanter Gewebeplasminogenaktivator (rt-PA) zur Notfallbehandlung der perioperativen lebensbedrohlichen Lungenembolie (Stadium IV). Anaesthesist 1991;40(6):309–14.

    CAS  PubMed  Google Scholar 

  44. Sigmund M, Rubart M, Vom Dahl J, et al. Successful treatment of massive pulmonary embolism by combined mechanical and thrombolytic therapy. J Interv Cardiol 1991;4(1):63–8.

    CAS  PubMed  Google Scholar 

  45. Westhoff-Bleck M, Gulba D, Claus G, et al. Lysetherapie bei protrahierter kardiopulmonaler Reanimation: Nutzen und Komplikationen. Z Kardiol 1991;80(suppl 3):139.

    Google Scholar 

  46. Scheeren TW, Hopf HB, Peters J. Intraoperative thrombolysis with rt-PA in massive pulmonary embolism during venous thrombectomy. Anästhesiol Intensivmed Notfallmed Schmerzther 1994;29(7):440–5.

    CAS  PubMed  Google Scholar 

  47. Ruiz-Bailen M, Aguayo-de-Hoyos E, Serrano-Corcoles MC, et al. Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series. Resuscitation 2001;51(1):97–101.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Field 110, D-69120, Heidelberg, Germany

    Fabian Spöhr & Bernd W. Böttiger

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  1. Fabian Spöhr
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  2. Bernd W. Böttiger
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Editors and Affiliations

  1. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Kunio Shirato M.D., Ph.D. (Professor) (Professor)

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© 2005 Springer-Verlag Tokyo

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Spöhr, F., Böttiger, B.W. (2005). Thrombolysis During Cardiopulmonary Resuscitation in Patients with Acute Pulmonary Embolism. In: Shirato, K. (eds) Venous Thromboembolism. Springer, Tokyo. https://doi.org/10.1007/4-431-27121-X_4

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  • DOI: https://doi.org/10.1007/4-431-27121-X_4

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-22080-0

  • Online ISBN: 978-4-431-27121-5

  • eBook Packages: MedicineMedicine (R0)

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