Oh No ! More work !

[Charles Brault <c.bro@videotron.ca>]

In the expectation that the pay-off will be really worth the extra workout.

Lancet 2001; 357: 1583-85


During cardiopulmonary resuscitation (CPR), thrombolysis can help to
stabilise patients with pulmonary embolism and myocardial infarction. 
Moreover, thrombolysis during CPR has beneficial effects on cerebral 
reperfusion after cardiac arrest. We investigated this new therapeutic 
approach in patients in whom conventional CPR had been unsuccessful.

Methods
We assessed, in a prospective study, patients undergoing CPR after 
out-of-hospital cardiac arrest for cardiological reasons in whom return of 
spontaneous circulation was
not achieved within 15 min. According to the Ustein criteria, our control group
consisted of patients who were assessed during 1 year. After this year 
patients were treated with a bolus of 5000 U of heparin and 50mg, over 2 
min, of tissue-type plasminogen activator (rt-PA treated group). This 
intervention was repeated if return of spontaneous circulation was not 
achieved within the following 30
min. For controls only CPR was given.

Findings
Overall, 90 patients were included; heparin and rt-PA were given to 40 
patients.
There were no bleeding complications related to the CPR procedures. Of the 
rt-PA
group, 68% (27) had return of spontaneous circulation and 58% (23) were 
admitted to a
cardiac intensive care unit, compared with 44% (22; p=0·026) and 30% (15; 
p=0·009) of the controls, respectively. At 24 h after cardiac arrest a 
larger proportion of the rt-PA group than of the controls was alive (35% 
[14] vs 22% [11], p=0·171), and 15% (six) of rt-PA-treated patients and 8% 
(four) of controls could be discharged from hospital.

Interpretation
After initially unsuccessful out-of-hospital CPR, thrombolytic therapy combined
with heparin is safe and might improve patient outcome. On the basis of our 
data a
randomised controlled trial might be regarded as ethical.


And also wondering it this can be done with or would exclude the use of an 
internal massage device ?
http://www.theracardia.com/

Charles Brault EMT-P

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