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Thrombolysis during CPR

Published:August 24, 2020DOI:https://doi.org/10.1016/j.ajem.2020.08.038
      Editor – Hamera et al. reported the successful cardiopulmonary resuscitation (CPR) of a 47-year-old patient with out-of-hospital cardiac arrest (OHCA) after administration of intravenous tissue plasminogen activator (t-PA) [
      • Hamera J.A.
      • et al.
      Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction.
      ]. This well-written case report relights the topic on systemic thrombolysis during CPR. Thrombolytics may rapidly induce reduction of plasma viscosity by cleavage of fibrinogen [
      • Hoffmann J.J.
      • et al.
      Blood viscosity during thrombolytic therapy with anistreplase in acute myocardial infarction.
      ]. Under the restricted conditions of ongoing CPR thrombolysis enhances microcirculation, improves coronary perfusion and most notably ameliorates cerebral reperfusion [
      • Fischer M.
      • et al.
      Thrombolysis using plasminogen activator and heparin reduces cerebral no-reflow after resuscitation from cardiac arrest: an experimental study in the cat.
      ]. Good neurologic outcome after administration of thrombolytic agents during CPR has been previously reported [
      • Schreiber W.
      • et al.
      Thrombolytic therapy after cardiac arrest and its effect on neurological outcome.
      ,
      • Lederer W.
      • et al.
      Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest.
      ].

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