[Thrombolysis during cardiopulmonary resuscitation]

It has been estimated that 50-70% of cardiac arrests are caused by acute myocardial infarction or fulminant pulmonary embolism. Thrombolysis could be the treatment of choice during cardiopulmonary resuscitation given its ability to treat the underlying cause of the condition. Traditionally thrombolysis during cardiopulmonary resuscitation has been contraindicated because of risk of life-threatening bleeding complications. Early clinical experience and results of several trials suggest that the risk of bleeding is lower and the overall clinical benefit is greater than previously thought. Imbalance between coagulation and fibrinolysis develops during cardiopulmonary resuscitation, followed by disseminated clotting in small vessels. This condition causes inadequate reperfusion of the brain. Experimental studies demonstrate that besides dissolving coronary thrombus or pulmonary emboli, thrombolytic therapy improves microcirculatory flow resulting in better reperfusion of the brain which translates into better neurological outcome after resuscitation. Should the currently ongoing "Thrombolysis In Cardiac Arrest - TROICA Study" confirm the results of the earlier trials, thrombolytic therapy may soon become part of the resuscitation guidelines.