Tissue Plasminogen Activator in Cardiac Arrest with Pulseless Electrical Activity

• Published in: The New England journal of medicine Vol. 346; no. 20; pp. 1522 - 1528
• Main Authors: Abu-Laban, Riyad B, Christenson, James M, Innes, Grant D, van Beek, Catherina A, Wanger, Karen P, McKnight, R. Douglas, MacPhail, Iain A, Puskaric, Joe, Sadowski, Richard P, Singer, Joel, Schechter, Martin T, Wood, Victor M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 16-05-2002
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiac arrest; Cardiopulmonary Resuscitation; CPR; Double-Blind Method; Electrophysiology; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medical Services; Fibrinolytic Agents - therapeutic use; Heart Arrest - drug therapy; Heart Arrest - mortality; Heart Arrest - physiopathology; Heart Arrest - therapy; Heart attacks; Humans; Intensive care medicine; Laboratory animals; Medical sciences; Pharmacology. Drug treatments; Pulse; Studies; Teaching hospitals; Tissue Plasminogen Activator - therapeutic use; Treatment Failure; Human; Intensive cardiocirculatory care; Cardiocirculatory arrest; Intravenous administration; Serine endopeptidases; Enzyme; Cardiovascular disease; Fibrinolysis; t-Plasminogen activator; Peptidases; Electromechanical dissociation; Chemotherapy; Treatment; Hydrolases; Adult; Fibrinolytic
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa012885

Coronary thrombosis and pulmonary embolism are common causes of cardiac arrest, providing a rationale for the use of thrombolytic therapy in cases of cardiac arrest. In this study, patients with cardiac arrest and pulseless electrical activity were randomly assigned to receive tissue plasminogen activator (t-PA) or placebo in a double-blind fashion. Treatment with t-PA did not increase either the rate of survival to hospital discharge or the rate of return of spontaneous circulation.
Treatment with t-PA did not increase the rate of survival to hospital discharge.
Out-of-hospital cardiac arrest results in some 250,000 deaths annually in the United States and Canada.
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Patients with pulseless electrical activity constitute 20 percent of victims of cardiac arrest, and only about 4 percent of such patients survive to be discharged from the hospital.
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Unlike other rhythms, pulseless electrical activity is frequently considered a state of severe shock, since some forward blood flow can occur.
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This observation has prompted heightened vigilance for reversible causes during treatment of pulseless electrical activity.
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That low-grade cerebral and coronary perfusion may persist during pulseless electrical activity supports the concept that the outcome can . . .