Thrombolytic therapy in patients requiring cardiopulmonary resuscitation

Alan N. Tenaglia, Robert M. Califf, Richard J. Candela, Dean J. Kereiakes, Eric Berrios, Sharon Y. Young, Richard S. Stack, Eric J. Topol

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Abstract

Cardiopulmonary resuscitation (CPR) is often considered a contraindication to thrombolytic therapy for acute myocardial infarction. Of 708 patients involved in the first 3 Thrombolysis and Angioplasty in Myocardial Infarction trials of lytic therapy for acute infarction, 59 patients required <10 minutes of CPR before receiving lytic therapy (CPR >10 minutes was an exclusion of the trials) or required CPR within 6 hours of treatment. The patients receiving CPR were similar to the remainder of the group with respect to baseline demographics. The indication for CPR was usually ventricular fibrillation (73%) or ventricular tachycardia (24%). The median duration of CPR was 1 minute, with twenty-fifth and seventy-fifth percentiles of 1 and 5 minutes, respectively. The median number of cardioversions/defibrillations performed was 2 (twenty-fifth and seventy-fifth percentiles of 1 and 3 minutes, respectively). Patients receiving CPR were more likely to have anterior infarctions (66 vs 39%), the left anterior descending artery as the infarct-related artery (63 vs 38%) and lower ejection fractions on the initial ventriculogram (46 ± 11 vs 52 ± 12%) than those not receiving CPR. Inhospital mortality was 12 vs 6% with most deaths due to pump failure (57%) or arrhythmia (29%) in the CPR group and pump failure (38%) or reinfarction (25%) in the non-CPR group. At 7 day follow-up the CPR group had a significant increase in ejection fraction (+5 ± 9%) compared with no change in non-CPR group. There were no bleeding complications directly attributed to CPR. In particular, the decrease in hematocrit (median 11) and need for transfusion (37 vs 32%) were the same in both groups. In addition, the CPR group did not spend more days in the cardiac care unit or in hospital than the non-CPR group. In conclusion, patients who have received CPR for <10 minutes had no additional complications attributable to thrombolytic therapy (95% confidence interval 0 to 5%). Therefore, CPR, especially of short duration, should not be considered a contraindication to lytic treatment. In addition, our results suggest that patients requiring CPR during acute infarction constitute a high-risk subgroup which may particularly benefit from receiving thrombolytic therapy.

Original languageEnglish (US)
Pages (from-to)1015-1019
Number of pages5
JournalThe American Journal of Cardiology
Volume68
Issue number10
StatePublished - Oct 15 1991

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tenaglia, A. N., Califf, R. M., Candela, R. J., Kereiakes, D. J., Berrios, E., Young, S. Y., Stack, R. S., & Topol, E. J. (1991). Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. The American Journal of Cardiology, 68(10), 1015-1019.