Rescue systemic thrombolysis during cardiopulmonary resuscitation

The main goal of the cardiopulmonary resuscitation is good neurological outcome. The primary ischaemic insult initiates a multitude of coagulation and inflammatory cascades resulting in cytotoxic brain oedema, necrosis and apoptosis. Thrombolytic agents may have experimentally and clinically significant beneficial effects in non-traumatic cardiac arrest. Prospective clinical trials show that thrombolytic therapy combined with heparin is feasible, safe and effective during resuscitation. We demonstrate three cases of successful systemic thrombolysis during in hospital CPR in cancer patients. Two patients were successfully resuscitated from cardiac arrest with streptase bolus (500.000 IU) and infusion (100,000/hr). One patient with pulmonary embolism and gynecological bleeding were treated with bolus (10,000 IU) and infusion of heparin (1,000 IU/hr) and successfully resuscitated. We observed a very good neurological outcome in all 3 cases following rescue thrombolysis and standard CPR. Two patients were discharged from hospital in good neurological outcome. One patient died on ICU on 10th day due to myocardial re-infarction and biventricular failure. Systemic thrombolysis is safe and effective treatment modality during resuscitative efforts even in cancer patients. In oncological patients with dissemination and/or bleeding heparin therapy should be considered due to better clinical control. (Ref. 17.)