Document Detail


Effects of thrombolysis during out-of-hospital cardiopulmonary resuscitation.
MedLine Citation:
PMID:  16442386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In this post hoc analysis, we assessed effects of thrombolysis during out-of-hospital cardiopulmonary resuscitation. The original study was designed as a double-blinded, prospective, multicenter, randomized, controlled clinical trial. In this report, 1,219 patients were randomized, but 33 patients were excluded due to missing study drug codes. Thus, 1,186 patients were analyzed based on receipt (n = 99) versus nonreceipt (n = 1,087) of thrombolysis; the primary end point was hospital admission, and the secondary end point was hospital discharge. Patients who received thrombolysis versus those who did not were significantly younger (mean +/- SD 62.7 +/- 13.3 vs 66.5 +/- 14.3 years of age, p = 0.01) and more likely to have had an acute myocardial infarction (75.3% vs 54.6%, p < 0.01) or pulmonary embolism (20.2% vs 12.0%, p = 0.03) as the suspected underlying cause for cardiac arrest. In patients who underwent thrombolysis versus those who did not, cardiac arrest was more often witnessed (86.9% vs 77.5%, p = 0.03), initial ventricular fibrillation was more likely (59.6% vs 38.0%, p < 0.01), and a short estimated interval (0 to 5 minutes) between collapse and initiation of basic life support was more likely (51.3% vs 29.2%, p < 0.01). In patients who received thrombolysis, sodium bicarbonate (45.5% vs 33.0%, p = 0.01), lidocaine (32.3% vs 18.1%, p < 0.01), and amiodarone (30.3% vs 12.2%, p < 0.01) were administered significantly more often. Hospital admission rates were significantly higher in patients who underwent thrombolysis than in patients who did not (45.5% vs 32.7%, p = 0.01), and there was a trend to higher hospital discharge rates (14.1% vs 9.5%, p = 0.14). In patients who had suspected myocardial infarction, hospital admission and discharge rates were significantly higher in patients who underwent thrombolysis than in patients who did not. In logistic regression models after adjusting for confounding variables (e.g., age, initial electrocardiographic rhythm, and initiation of basic life support), hospital admission and discharge rates did not differ significantly. In conclusion, even when being employed in patients with a potentially better chance to survive, thrombolysis in patients with cardiac arrest resulted in an increased hospital admission but not discharge rate in this post hoc analysis.
Authors:
Karl H Stadlbauer; Anette C Krismer; H Richard Arntz; Viktoria D Mayr; Hannes G Lienhart; Bernd W Böttiger; Beate Jahn; Karl H Lindner; Volker Wenzel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-12-01
Journal Detail:
Title:  The American journal of cardiology     Volume:  97     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-04-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  305-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. karl-heinz.stadlbauer@uibk.ac.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation / methods*
Emergency Medical Services
Female
Fibrinolytic Agents / therapeutic use*
Heart Arrest / drug therapy*,  etiology
Humans
Male
Middle Aged
Myocardial Infarction / complications
Pulmonary Embolism / complications
Thrombolytic Therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Am J Cardiol. 2006 Aug 15;98(4):570   [PMID:  16893722 ]
Am J Cardiol. 2006 Aug 1;98(3):426-7   [PMID:  16860043 ]

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