Intra-cardiac arrest thrombolysis in the pre-hospital setting: four cases worth considering
Hitt, Andy Pateman, Jane
Hitt, Andy
Pateman, Jane
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Abstract
Abstract published with permission.
Background: It has been estimated that over 400 000 people have an outof-hospital cardiac arrest (OHCA) annually in the United States and Europe
combined, of whom fewer than 10% survive to hospital discharge. In up to 70%
of cases OHCA is caused by underlying acute coronary disease or pulmonary
embolism, and as such the benefits of thrombolytic therapy during resuscitation
attempts have been explored without there being a clear conclusion.
This paper presents a case series of four victims of OHCA who received
thrombolysis, with adjunctive antithrombotic therapy, in the pre-hospital phase
of their treatment. Three of these were attended by a critical care paramedic
(CCP)—a paramedic with advanced training in emergency care—who received
online physician support. The other victim was attended by paramedics and a
physician who is experienced in pre-hospital emergency care.
Discussion: Although there is much debate about the efficacy of routine
administration of thrombolytic therapy during OHCA, cases such as those
featured in this paper indicate a need for clinicians to consider the merits of prehospital thrombolysis (PHT) based on individual patient characteristics and the
circumstances leading to their presenting condition.
Conclusions: Lives can be saved with the timely administration of intra-arrest
PHT but candidates should be selected with great care. This may be best
delivered in systems where clinicians at scene are supported by expert medical
advice, allowing clinicians to recognise and treat this small but important group
of survivors.