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

Research output: Contribution to journalArticle

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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
Pages (from-to)1015-1019
Number of pages5
JournalThe American journal of cardiology
Volume68
Issue number10
StatePublished - Oct 15 1991
Externally publishedYes

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Thrombolytic Therapy
Cardiopulmonary Resuscitation
Resuscitation
Infarction
Arteries
Myocardial Infarction
Electric Countershock
Ventricular Fibrillation
Ventricular Tachycardia
Hospital Mortality
Angioplasty
Hematocrit
Cardiac Arrhythmias
Therapeutics

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., ... Topol, E. J. (1991). Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. The American journal of cardiology, 68(10), 1015-1019.

Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. / Tenaglia, Alan N.; Califf, Robert M.; Candela, Richard J.; Kereiakes, Dean J.; Berrios, Eric; Young, Sharon Y.; Stack, Richard S.; Topol, Eric J.

In: The American journal of cardiology, Vol. 68, No. 10, 15.10.1991, p. 1015-1019.

Research output: Contribution to journalArticle

Tenaglia, AN, Califf, RM, Candela, RJ, Kereiakes, DJ, Berrios, E, Young, SY, Stack, RS & Topol, EJ 1991, 'Thrombolytic therapy in patients requiring cardiopulmonary resuscitation', The American journal of cardiology, vol. 68, no. 10, pp. 1015-1019.
Tenaglia AN, Califf RM, Candela RJ, Kereiakes DJ, Berrios E, Young SY et al. Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. The American journal of cardiology. 1991 Oct 15;68(10):1015-1019.
Tenaglia, Alan N. ; Califf, Robert M. ; Candela, Richard J. ; Kereiakes, Dean J. ; Berrios, Eric ; Young, Sharon Y. ; Stack, Richard S. ; Topol, Eric J. / Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. In: The American journal of cardiology. 1991 ; Vol. 68, No. 10. pp. 1015-1019.
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title = "Thrombolytic therapy in patients requiring cardiopulmonary resuscitation",
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.",
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N2 - 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.

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