| [Thrombolysis during cardio-pulmonary resuscitation]. | |
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MedLine Citation:
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PMID: 20922642 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Sudden cardiac death is a leading cause of death in Europe. In the vast majority, myocardial infarction or pulmonary embolism is the underlying cause. Lethality is still high, especially if the arrest occurs out of hospital. For these two severe conditions, thrombolysis has proven to be an established therapy. Coronary perfusion is restored or the occlusion in the pulmonary arteries is removed, restoring normal circulation and normalising right-ventricular afterload. Nevertheless, thrombolysis was contraindicated during cardio-pulmonary resuscitation (CPR) for many years due to the fear of severe bleeding complications. Case reports and series using thrombolysis as successful ultima ratio therapy during prolonged CPR were soon followed by retrospective and interventional studies. These trials showed significantly improved survival for patients after thrombolysis during CPR. Nevertheless, none of these trials was randomised. Other trials showed that bleeding complications do not occur more frequently after thrombolysis during CPR. Experimental investigations demonstrated that thrombolysis during CPR improves cerebral microcirculation. The results of the randomised, multicenter trial TROICA show that tenecteplase alone, does not significantly improve survival. Further studies on thrombolysis during CPR with additional administration of heparin and acetylsalicylic acid must follow to ascertain the role of thrombolysis during CPR. Although thrombolysis during CPR is not a standard therapy, it should not be withheld from patients in whom pulmonary embolism is the suspected cause of cardiac arrest, as well as in selected other patients on the physician's individual decision according to recent guidelines. |
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Authors:
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W A Wetsch; F Spöhr; P Teschendorf; B W Böttiger; S A Padosch |
Publication Detail:
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Type: English Abstract; Journal Article; Review Date: 2010-10-04 |
Journal Detail:
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Title: Deutsche medizinische Wochenschrift (1946) Volume: 135 ISSN: 1439-4413 ISO Abbreviation: Dtsch. Med. Wochenschr. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-05 Completed Date: 2010-10-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0006723 Medline TA: Dtsch Med Wochenschr Country: Germany |
Other Details:
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Languages: ger Pagination: 1983-8 Citation Subset: IM |
Copyright Information:
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© Georg Thieme Verlag KG Stuttgart · New York. |
Affiliation:
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Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Köln, Germany. |
Vernacular Title:
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Thrombolyse während der kardiopulmonalen Reanimation. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aspirin
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adverse effects,
therapeutic use Cardiopulmonary Resuscitation / methods* Death, Sudden, Cardiac / etiology* Fibrinolytic Agents / adverse effects, therapeutic use Hemorrhage / chemically induced, mortality Heparin / adverse effects, therapeutic use Humans Multicenter Studies as Topic Myocardial Infarction / drug therapy*, mortality Pulmonary Embolism / drug therapy*, mortality Randomized Controlled Trials as Topic Recombinant Proteins / adverse effects, therapeutic use Survival Rate Thrombolytic Therapy / adverse effects, contraindications, methods* Tissue Plasminogen Activator / adverse effects, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Recombinant Proteins; 0/tenecteplase; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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