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Thrombolytic therapy in patients requiring cardiopulmonary resuscitation
A N Tenaglia1, R M Califf, R J Candela
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Cardiopulmonary resuscitation (CPR) before thrombolytic therapy for acute myocardial infarction is safe and does not increase bleeding complications. Patients receiving CPR showed improved ejection fraction post-treatment.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Cardiopulmonary resuscitation (CPR) is often viewed as a contraindication for thrombolytic therapy in acute myocardial infarction (AMI).
- Limited data exists on the safety and outcomes of administering thrombolytic therapy to AMI patients who require CPR.
Purpose of the Study:
- To evaluate the safety and outcomes of thrombolytic therapy in acute myocardial infarction patients who received cardiopulmonary resuscitation.
Main Methods:
- Analysis of 708 patients from the Thrombolysis and Angioplasty in Myocardial Infarction trials.
- Inclusion criteria: patients requiring <10 minutes of CPR before lytic therapy or CPR within 6 hours of treatment.
- Comparison of baseline demographics, CPR indications, duration, interventions, infarct characteristics, and in-hospital outcomes between CPR and non-CPR groups.
Main Results:
- 59 patients received CPR, primarily for ventricular fibrillation (73%) or ventricular tachycardia (24%), with a median CPR duration of 1 minute.
- CPR patients had higher rates of anterior infarctions, left anterior descending artery involvement, and lower initial ejection fractions.
- In-hospital mortality was higher in the CPR group (12% vs 6%), mainly due to pump failure or arrhythmia.
- The CPR group showed a significant ejection fraction increase at 7 days (+5%), unlike the non-CPR group.
Conclusions:
- Thrombolytic therapy following short-duration CPR in acute myocardial infarction is not associated with increased bleeding complications.
- While CPR patients experienced higher mortality, they demonstrated improved cardiac function post-treatment.
- These findings suggest that CPR should not be an absolute contraindication to thrombolytic therapy in AMI.
Abstract:
Cardiopulmonary resuscitation (CPR) is often considered a contraindication to thrombolytic therapy for acute myocardial infarction. Of 708 patients involved in the first 3 Thrombolysis and Angioplasty in Myocardial Infarction trials of lytic therapy for acute infarction, 59 patients required less than 10 minutes of CPR before receiving lytic therapy (CPR greater than 10 minutes was an exclusion of the trials) or required CPR within 6 hours of treatment. The patients receiving CPR were similar to the remainder of the group with respect to baseline demographics. The indication for CPR was usually ventricular fibrillation (73%) or ventricular tachycardia (24%). The median duration of CPR was 1 minute, with twenty-fifth and seventy-fifth percentiles of 1 and 5 minutes, respectively. The median number of cardioversions/defibrillations performed was 2 (twenty-fifth and seventy-fifth percentiles of 1 and 3 minutes, respectively). Patients receiving CPR were more likely to have anterior infarctions (66 vs 39%), the left anterior descending artery as the infarct-related artery (63 vs 38%) and lower ejection fractions on the initial ventriculogram (46 +/- 11 vs 52 +/- 12%) than those not receiving CPR. In-hospital mortality was 12 vs 6% with most deaths due to pump failure (57%) or arrhythmia (29%) in the CPR group and pump failure (38%) or reinfarction (25%) in the non-CPR group. At 7 day follow-up the CPR group had a significant increase in ejection fraction (+5 +/- 9%) compared with no change in non-CPR group. There were no bleeding complications directly attributed to CPR.(ABSTRACT TRUNCATED AT 250 WORDS)