A pilot randomised trial of thrombolysis in cardiac arrest (The TICA trial)

The outcome after out of hospital cardiac arrest is dismal. Thrombolysis during CPR has been advocated. Our hypothesis was that early administration of bolus thrombolysis could lead to improved survival from out of hospital cardiac arrest.

A prospective, randomised, double blind placebo controlled trial. All victims of out of hospital cardiac arrest brought to the Emergency Department (ED) by the emergency medical system were eligible for inclusion. All patients received standard advanced cardiac life support, except that the first drug the patient received was either tenecteplase 50 mg or placebo. The primary end point was return of spontaneous circulation (ROSC).

Of 35 patients enrolled, 19 received tenecteplase and 16 placebo. The tenecteplase group was younger (63 vs 72 years P = 0.04) and had significantly more ventricular fibrillation as the initial rhythm (63% versus 19%, 44% difference, 95% CI 15-73%). There was no difference in rhythm on arrival at the ED. ROSC occurred in 8 (42%) patients receiving tenecteplase and one (6%) placebo (36% difference, 95% CI 11-61%). Two tenecteplase and one placebo patient survived to leave ED, and one in each group survived to hospital discharge. Autopsy results were available on eight patients, five of whom had a thrombotic cause of death.

In this pilot study, we found the use of early bolus tenecteplase for OHCA to be feasible, and that it appears to increase the rate of ROSC. Larger studies are required to determine if this translates into a survival benefit. Appropriate patient selection for OHCA studies remains problematic.