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Published on: April 19, 2024
Hyperfibrinolysis is common in out-of-hospital cardiac arrest: results from a prospective observational
H Schöchl1, J Cadamuro, S Seidl
1Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. Herbert.schoechl@auva.at
Insights
Coagulation differences were found in out-of-hospital cardiac arrest (OHCA) patients. Rotational thromboelastometry revealed significant hyperfibrinolysis, suggesting caution with routine fibrinolytic therapy during cardiopulmonary resuscitation (CPR).
Area of Science:
- Emergency Medicine
- Critical Care
- Hematology
Background:
- Cardiocirculatory arrest (CCA) activates procoagulant pathways and inhibits fibrinolysis, leading to impaired blood flow.
- Previous studies have not utilized whole-blood viscoelastic tests to assess coagulation and fibrinolysis in out-of-hospital cardiac arrest (OHCA).
Purpose of the Study:
- To characterize coagulation and fibrinolysis in OHCA patients using rotational thromboelastometry (ROTEM).
- To compare coagulation profiles between OHCA patients who achieved return of spontaneous circulation (ROSC) and those who did not.
Main Methods:
- Fifty-three OHCA patients undergoing cardiopulmonary resuscitation (CPR) were enrolled.
- Blood samples were analyzed for complete blood count, standard coagulation tests, and ROTEM (EXTEM) analyses.
- Patients were categorized into ROSC and non-ROSC groups for comparison.
Main Results:
- Non-ROSC patients exhibited significantly lower prothrombin time index (PTI) and prolonged activated partial thromboplastin time (aPTT) compared to ROSC patients.
- EXTEM clotting time (CT) was significantly longer in non-ROSC versus ROSC patients.
- Hyperfibrinolysis (maximum lysis >15%) was observed in 35.8% of patients, with no significant difference between ROSC and non-ROSC groups.
Conclusions:
- Significant differences in PTI, aPTT, and EXTEM CT were identified between OHCA patients with and without ROSC.
- Hyperfibrinolysis is more prevalent in OHCA patients than previously recognized.
- Routine fibrinolytic therapy in all prolonged CPR patients is not recommended based on these findings.
Background:
Cardiocirculatory arrest (CCA) activates procoagulant pathways. It has also been reported to inhibit fibrinolysis, resulting in fibrin deposition and further impairment of blood flow. Until now, no studies have used whole-blood viscoelastic tests to characterize coagulation and the impact of fibrinolysis in out-of-hospital cardiac arrest (OHCA).
Methods:
Patient with established OHCA who underwent cardiopulmonary resuscitation (CPR) were enrolled. Blood samples were obtained immediately after placement of an intravenous line at the scene, for full blood cell count, standard coagulation tests and rotational thromboelastometric (ROTEM(®)) analyses. Patients with return of spontaneous circulation (ROSC) were compared to non-ROSC patients.
Results:
Fifty-three patients (median age 67 years, interquartile range: 56-73 years) were included in the study. ROSC was established in 25 patients. Prothrombin time index (PTI) was significantly lower and activated partial thromboplastin time (aPTT) was significantly prolonged in non-ROSC patients compared to ROSC patients. Clotting time (CT) in the extrinsically activated ROTEM test (EXTEM) was significantly longer in non-ROSC versus ROSC patients. For the remaining EXTEM parameters, there were no significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis (maximum lysis>15% according to ROTEM test results) was observed in 19 patients (35.8%). There was no difference between ROSC and non-ROSC patients in the incidence of hyperfibrinolysis.
Conclusions:
PTI, aPTT and EXTEM CT revealed significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis according to ROTEM test results was much more common than previously assumed. Routine use of fibrinolytic therapy in all patients with prolonged CPR cannot therefore be recommended.
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