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Tissue plasminogen activator in cardiac arrest with pulseless electrical activity
Riyad B Abu-Laban1, James M Christenson, Grant D Innes
1Division of Emergency Medicine, University of British Columbia, Vancouver, Canada. abulaban@interchange.ubc.ca
The New England Journal of Medicine
|May 17, 2002
Summary
This study found no survival benefit from administering tissue plasminogen activator (t-PA) during cardiopulmonary resuscitation for cardiac arrest. Fibrinolysis did not improve survival rates in patients with pulseless electrical activity.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- Coronary thrombosis and pulmonary thromboembolism are leading causes of cardiac arrest.
- Investigated the efficacy of tissue plasminogen activator (t-PA) in cardiac arrest patients with pulseless electrical activity (PEA).
Purpose of the Study:
- To determine if t-PA administration during cardiopulmonary resuscitation (CPR) improves survival in cardiac arrest patients with PEA of cardiovascular origin.
Main Methods:
- A double-blind, placebo-controlled trial enrolled 233 patients (age >16) with unresponsive PEA.
- Patients received either 100 mg t-PA or placebo intravenously during CPR.
- Primary outcome was survival to hospital discharge.
Main Results:
- Only one patient in the t-PA group survived to discharge versus none in the placebo group (0.9% difference).
- Return of spontaneous circulation occurred in 21.4% of the t-PA group and 23.3% of the placebo group.
- No statistically significant difference in survival or circulation return between groups.
Conclusions:
- Fibrinolysis with t-PA showed no beneficial effect in cardiac arrest patients with PEA of presumed cardiovascular cause.
- The study had limited statistical power, suggesting a potential small treatment effect or benefit in specific subgroups cannot be ruled out.