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Updated: Aug 19, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series
P A Tiffany1, M Schultz, H Stueven
1Emergency Department, Waukesha Memorial Hospital, WI, USA.
Insights
Thrombolytic therapy, specifically tissue plasminogen activator, may help restore circulation in cardiac arrest patients with acute myocardial infarction and refractory ventricular fibrillation or tachycardia during cardiopulmonary resuscitation (CPR). This approach showed promise in three cases, leading to successful resuscitation and discharge without adverse effects.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Thrombolytic therapy is standard for acute myocardial infarction.
- Historically, thrombolytic therapy was contraindicated during cardiopulmonary resuscitation (CPR).
- The efficacy of thrombolytics in refractory cardiac arrest has not been well-studied.
Observation:
- Three patients with acute myocardial infarction experienced witnessed cardiac arrest in the ED.
- Standard Advanced Cardiac Life Support (ACLS) measures were ineffective in these cases.
- Tissue plasminogen activator (tPA) was administered intravenously during CPR for refractory ventricular fibrillation/tachycardia.
Findings:
- Following tPA administration and defibrillation, all three patients achieved spontaneous return of circulation.
- Successful resuscitation occurred in all cases, with subsequent discharge.
- No adverse sequelae related to thrombolytic use during resuscitation were observed.
Implications:
- Bolus thrombolytic infusions during CPR may be a viable strategy for select patients.
- This approach could facilitate spontaneous circulation return in acute myocardial infarction patients with refractory arrest.
- Further investigation into thrombolytic use during CPR is warranted for refractory cardiac arrest scenarios.
Abstract:
Thrombolytic therapy has been accepted in the treatment of acute myocardial infarction. Given historical recommendations that thrombolytic therapy is contraindicated in patients receiving CPR, its potential clinical benefit for facilitating conversion of rhythm in patients in refractory cardiac arrest has not been investigated. We present three case reports in which patients with confirmed acute myocardial infarction had a witnessed cardiac arrest in the ED. Standard Advanced Cardiac Life Support measures failed in all three cases. A bolus infusion of tissue plasminogen activator was administered during CPR in refractory ventricular fibrillation (two cases) and pulseless ventricular tachycardia (one case). Patients were given tissue plasminogen activator and had defibrillation, followed by a spontaneous return of circulation, with resuscitation and subsequent discharge. No postarrest sequelae were observed as a result of thrombolytic use during the resuscitative process. We conclude that bolus thrombolytic infusions during CPR may facilitate spontaneous return of circulation in select patients with confirmed acute myocardial infarction, witnessed cardiac arrest in the ED, and refractory ventricular fibrillation or tachycardia.
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