Successful use of intra-arrest thrombolysis for electrical storm due to acute myocardial infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Critical Care

Background:

• Acute vascular thrombotic events, such as myocardial infarction and pulmonary embolism, are primary causes of sudden cardiac arrest.
• Current guidelines recommend against routine intra-arrest thrombolysis due to ongoing debate regarding its efficacy.
• Electrical storm, characterized by recurrent ventricular fibrillation, poses a significant challenge in cardiac arrest management.

Observation:

• A patient presented with prolonged refractory ventricular fibrillation electrical storm.
• Intra-arrest electrocardiographic and sonographic findings confirmed acute myocardial infarction as the underlying cause.
• Rescue intra-arrest thrombolysis was administered as a last resort.

Findings:

• Rapid return of spontaneous circulation was achieved following the intra-arrest thrombolytic bolus.
• The case demonstrates a potential positive outcome in a refractory cardiac arrest scenario.
• Successful thrombolysis reversed the acute thrombotic event, facilitating ROSC.

Implications:

• This case suggests that intra-arrest thrombolysis could be a viable rescue strategy in selected cardiac arrest patients with confirmed acute myocardial infarction.
• Careful patient selection, based on clear evidence of acute thrombosis, is crucial for optimizing outcomes.
• Further research is warranted to define the precise role and optimal use of thrombolysis during cardiac arrest.