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Updated: Apr 17, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
[Clinical practice of systemic lysis in prehospital resuscitation. Success and complication rates]
S Everding1, S Römer2, A Bohn3
1Department für Kardiologie und Angiologie, Klinik für Kardiologie, Universitätsklinikum Münster, Laukamp 7, 48161, Münster, Deutschland. silvia.everding@web.de.
Insights
Systemic thrombolysis in prehospital cardiac arrest is debated. It may be beneficial for acute pulmonary embolism or myocardial infarction, but not as a last resort for younger patients with persistent ventricular fibrillation.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Systemic thrombolysis is a prehospital treatment for cardiac arrest due to acute myocardial ischemia or pulmonary embolism.
- Its efficacy and appropriate use in this setting remain under discussion.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of prehospital systemic thrombolysis in patients with sudden cardiac arrest.
- To compare patients who received thrombolysis with those who did not, analyzing resuscitation success and in-hospital course.
Main Methods:
- Retrospective case-control study of 194 patients with prehospital cardiac arrest.
- Comparison of 96 patients who received thrombolysis versus 98 who did not.
- Analysis included circumstances of arrest, resuscitation success, in-hospital outcomes, bleeding complications, survival, and neurological status.
Main Results:
- Thrombolysis patients were younger and more often on anticoagulants, antiplatelets, and amiodarone.
- A trend towards increased prehospital return of spontaneous circulation (ROSC) was observed with thrombolysis.
- No significant differences in bleeding complications were noted due to small sample size.
Conclusions:
- Systemic thrombolysis should be reserved for prehospital cardiac arrest with clear acute pulmonary embolism or recurrent ventricular fibrillation in myocardial infarction.
- Evidence does not support using systemic thrombolysis as a last resort in younger patients with persistent ventricular fibrillation.
Background:
Systemic thrombolysis was introduced as the sole prehospital treatment option in patients with cardiac arrest in the setting of acute myocardial ischemia or pulmonary embolism; however, it remains the subject of discussion.
Patients And Methods:
A total of 194 patients with sudden prehospital cardiac arrest were included in this retrospective case control study. Of these patients, 96 in whom circulatory arrest due to cardiac disease (pulmonary artery embolism or myocardial ischemia) was suspected underwent thrombolytic treatment and were compared to the remaining 98 patients that did not undergo thrombolytic therapy. In addition to the circumstances of circulatory arrest, the course and success of resuscitation, as well as in-hospital course (including bleeding complications), overall survival and neurological outcomes were compared.
Results:
There were no significant differences between patients with or without thrombolysis in terms of the circumstances of cardiac arrest. Patients that received thrombolytic treatment were significantly younger and were more frequently treated with anticoagulants, platelet aggregation inhibitors and amiodarone. They also received higher doses of epinephrine and arrived at hospital under ongoing resuscitation significantly more frequently. A trend toward more prehospital return of spontaneous circulation (ROSC) following thrombolytic treatment was seen in the entire cohort. However, patients pre-treated with acetylsalicylic acid and heparin did not show better prehospital ROSC rates as a result of additional thrombolytic therapy. Significant differences in terms of bleeding complications or the need for blood transfusion could not be seen due to the small number of patients.
Discussion:
The indication for systemic thrombolysis in the context of prehospital resuscitation should remain restricted to patients with clear symptoms of acute pulmonary embolism or recurrent episodes of ventricular fibrillation in the setting of acute myocardial infarction. Due to a lack of evidence, systemic thrombolysis should not be used as a treatment of last resort in younger patients with persistent ventricular fibrillation.
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