Skip to main content
SpringerLink
Log in

Safety of Thrombolysis during Cardiopulmonary Resuscitation

  • Current Opinion
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

The prognosis is generally poor for patients who experience a cardiac arrest. The most common causes of sudden cardiac arrest are massive pulmonary embolism (PE) and acute myocardial infarction (MI). While thrombolysis is a first-line treatment option in massive PE and acute MI, cardiopulmonary resuscitation (CPR) has been regarded as a relative contraindication for thrombolysis because of the anticipated bleeding risk caused by traumatic cardiocompressions. However, an increasing number of case reports and clinical studies on thrombolysis during and after CPR highlight an increased frequency of the return of spontaneous circulation and a better neurological outcome of surviving patients. These effects are mainly due to the thrombolysis of macroscopic blood clots and the amelioration of microcirculatory reperfusion.

This article reviews case reports and clinical studies of thrombolysis during and shortly after CPR in order to estimate the risk of severe bleeding events caused by CPR in association with thrombolysis compared with CPR without thrombolysis.

Although thrombolysis per se can cause severe and potentially fatal haemorrhage, there is no evidence that severe bleeding events occur more often when thrombolysis is combined with cardiocompressions. In addition, by far the majority of bleeding complications can be treated effectively. Thus, in many cases, the possible benefit of thrombolysis during CPR seems to outweigh the potential risks. However, there may be a publication bias in some case reports and studies towards reporting successful rather than unsuccessful CPRs. In addition, not enough controlled clinical trials have yet been conducted. Therefore, data from large randomised, multicentre studies are needed to definitely answer the question of the relationship between safety and efficacy of this promising treatment option.

We conclude that the currently available data do not indicate that thrombolysis contributes to a significant increase in bleeding complications when administered during CPR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V
Table VI

Similar content being viewed by others

References

  1. Bedell SE, Delbanco TL, Cook EF, et al. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983; 309(10): 569–76

    Article  PubMed  CAS  Google Scholar 

  2. Ballew KA, Philbrick JT, Caven DE, et al. Predictors of survival following in-hospital cardiopulmonary resuscitation: a moving target. Arch Intern Med 1994; 154(21): 2426–32

    Article  PubMed  CAS  Google Scholar 

  3. Newman DH, Greenwald I, Callaway CW. Cardiac arrest and the role of thrombolytic agents. Ann Emerg Med 2000; 35(5): 472–80

    PubMed  CAS  Google Scholar 

  4. Silfvast T. Cause of death in unsuccessful prehospital resuscitation. J Intern Med 1991; 229(4): 331–5

    Article  PubMed  CAS  Google Scholar 

  5. Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism: a comprehensive review of current evidence. Chest 1999; 115(6): 1695–707

    Article  PubMed  CAS  Google Scholar 

  6. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994; 343 (8893): 311–22

    Google Scholar 

  7. Böttiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet 2001; 357(9268): 1583–5

    Article  PubMed  Google Scholar 

  8. Lederer W, Lichtenberger C, Pechlaner C, et al. Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest. Resuscitation 2001; 50(1): 71–6

    Article  PubMed  CAS  Google Scholar 

  9. Curzen N, Haque R, Timmis A. Applications of thrombolytic therapy. Intensive Care Med 1998; 24(8): 756–68

    Article  PubMed  CAS  Google Scholar 

  10. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1999; 100(9): 1016–30

    Article  PubMed  CAS  Google Scholar 

  11. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Acute myocardial infarction: pre-hospital and in-hospital management. Eur Heart J 1996; 17 (1): 43–63

    Google Scholar 

  12. Ruiz-Bailén M, Aguayo de Hoyos E, Diaz-Castellanos MA. Role of thrombolysis in cardiac arrest. Intensive Care Med 2001; 27(2): 438–41

    Article  PubMed  Google Scholar 

  13. Califf RM, Fortin DF, Tenaglia AN, et al. Clinical risks of thrombolytic therapy. Am J Cardiol 1992; 69: 12A–20A

    Article  PubMed  CAS  Google Scholar 

  14. Lee HS. How safe is the readministration of streptokinase. Drug Saf 1995; 13(2): 76–80

    Article  PubMed  CAS  Google Scholar 

  15. Verstraete M. Third-generation thrombolytic drugs. Am J Med 2000; 109(1): 52–8

    Article  PubMed  CAS  Google Scholar 

  16. White HD. Comparative safety of thrombolytic agents. Am J Cardiol 1991; 68(16): 30E–37E

    Article  PubMed  CAS  Google Scholar 

  17. Kanter DS, Mikkola KM, Patel SR, et al. Thrombolytic therapy for pulmonary embolism: frequency of intracranial hemorrhage and associated risk factors. Chest 1997; 111(5): 1241–5

    Article  PubMed  CAS  Google Scholar 

  18. Böttiger BW, Böhrer H, Bach A, et al. Bolus injection of thrombolytic agents during cardiopulmonary resuscitation for massive pulmonary embolism. Resuscitation 1994; 28(1): 45–54

    Article  PubMed  Google Scholar 

  19. Kürkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000; 160(10): 1529–35

    Article  PubMed  Google Scholar 

  20. Bedell SE, Fulton EJ. Unexpected findings and complications at autopsy after cardiopulmonary resuscitation (CPR). Arch Intern Med 1986; 146(9): 1725–8

    Article  PubMed  CAS  Google Scholar 

  21. Powner DJ, Holcombe PA, Mello LA. Cardiopulmonary resuscitation- related injuries. Crit Care Med 1984; 12(1): 54–5

    Article  PubMed  CAS  Google Scholar 

  22. Krischer JP, Fine EG, Davis JH, et al. Complications of cardiac resuscitation. Chest 1987; 92(2): 287–91

    Article  PubMed  CAS  Google Scholar 

  23. Gueugniaud PY. Subarachnoid hemorrhage: a complication of CPR? Crit Care Med 1987; 15(3): 284–5

    Article  PubMed  CAS  Google Scholar 

  24. Merriman CS, Kalbfleisch ND. Thrombolysis in acute myocardial infarction following prolonged cardiopulmonary resuscitation. Acad Emerg Med 1994; 1(1): 61–6

    Article  PubMed  CAS  Google Scholar 

  25. Pharo G, Andonakakis A, Chandrasekaren K. Survival from catastrophic intraoperative pulmonary embolism. Anesth Analg 1995; 81: 188–90

    PubMed  CAS  Google Scholar 

  26. The ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM): Mortality, morbidity, and infarct size at 21 days. N Engl J Med 1986; 314 (23): 1465–71

    Google Scholar 

  27. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; II (8607): 349–60

    Google Scholar 

  28. Kennedy JW, Ritchie JL, Davis KB, et al. Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. N Engl J Med 1983; 309(24): 1477–82

    Article  PubMed  CAS  Google Scholar 

  29. Wilcox RG, von der Lippe G, Olsson CG, et al. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 1988; II(8610): 525–30

    Article  Google Scholar 

  30. Flügel H, Bartels O, von der Emde J. Treatment of severe lung embolism under conditions of reanimation. Fortschr Med 1978; 96(12): 639–42

    PubMed  Google Scholar 

  31. Haugeberg G, Bonarjee V, Dickstein K. Fatal intrathoracic haemorrhage after cardiopulmonary resuscitation and treatment with streptokinase and heparin. Br Heart J 1989; 62(2): 157–8

    Article  PubMed  CAS  Google Scholar 

  32. Pezzi A, Pasetti G, Lombardi F, et al. Liver rupture after cardiopulmonary resuscitation (CPR) and thrombolysis. Intensive Care Med 1999; 25(9): 1032

    Article  PubMed  CAS  Google Scholar 

  33. Cafri C, Gilutz H, Ilia R, et al. Unusual bleeding complications of thrombolytic therapy after cardiopulmonary resuscitation: three case reports. Angiology 1997; 48(10): 925–8

    Article  PubMed  CAS  Google Scholar 

  34. Adams HA, Schmitz CS, Block G, et al. Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy. Anaesthesist 1995; 44(8): 585–9

    Article  PubMed  CAS  Google Scholar 

  35. Druwé PM, Cools FJ, De Raedt HJ, et al. Liver rupture after cardiopulmonary resuscitation in a patient receiving thrombolytic therapy. Resuscitation 1996; 32(3): 213–6

    Article  PubMed  Google Scholar 

  36. Tenaglia AN, Califf RM, Candela RJ, et al. Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. Am J Cardiol 1991; 68(10): 1015–9

    Article  PubMed  CAS  Google Scholar 

  37. Scholz KH, Tebbe U, Herrmann C, et al. Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 1992; 69(8): 724–8

    Article  PubMed  CAS  Google Scholar 

  38. Ruiz-Bailéin M, Aguayo de Hoyos E, Serrano-Córcoles MC, et al. Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation. Intensive Care Med 2001; 27(6): 1050–7

    Article  Google Scholar 

  39. Voipio V, Kuisma M, Alaspaa A, et al. Thrombolytic treatment of acute myocardial infarction after out-of-hospital cardiac arrest. Resuscitation 2001; 49(3): 251–8

    Article  PubMed  CAS  Google Scholar 

  40. Schreiber W, Gabriel D, Sterz F, et al. Thrombolytic therapy after cardiac arrest and its effect on neurological outcome. Resuscitation 2002; 52(1): 63–9

    Article  PubMed  CAS  Google Scholar 

  41. Kürkciyan I Meron G, Sterz F, at al. Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment. J Intern Med 2003; 253(2): 128–35

    Article  Google Scholar 

  42. Jäger D, Machraoui A, Melz F, et al. Systemic fibrinolysis following resuscitation or temporary electrostimulation. Dtsch Med Wochenschr 1990; 115(26): 1009–13

    Article  PubMed  Google Scholar 

  43. Scholz KH, Hilmer T, Schuster S, et al. Thrombolysis in resuscitated patients with pulmonary embolism. Dtsch Med Wochenschr 1990; 115(24): 930–5

    Article  PubMed  CAS  Google Scholar 

  44. Cross SJ, Lee HS, Rawles JM, et al. Safety of thrombolysis in association with cardiopulmonary resuscitation. BMJ 1991; 303(6812): 1242

    Article  PubMed  CAS  Google Scholar 

  45. van Campen LC, van Leeuwen GR, Verheugt FW. Safety and efficacy of thrombolysis for acute myocardial infarction in patients with prolonged out-of-hospital cardiopulmonary resuscitation. Am J Cardiol 1994; 73(13): 953–5

    Article  PubMed  Google Scholar 

  46. Renkes-Hegendörfer U, Herrmann K. Successful treatment of a case of fulminant massive pulmonary embolism with streptokinase. Anaesthesist 1974; 23: 500–1

    PubMed  Google Scholar 

  47. Lapostolle F, Pommerie F, Catineau J, et al. Out-of-hospital thrombolysis in cardiac arrest after unsuccessful resuscitation. Am J Emerg Med 2001; 19(4): 327–9

    Article  PubMed  CAS  Google Scholar 

  48. Unseld H, Hillenbrand F, Heinsius P. Streptokinase in pulmonary embolisation with cardiac arrest. Anaesthesist 1978; 27(7): 333–5

    PubMed  CAS  Google Scholar 

  49. Wester HA, Orellano L, Fenyes-Bellmann J, et al. Successful treatment of a massive pulmonary embolism after 90-minute external heart massage. Dtsch Med Wochenschr 1986; 111(30): 1151–4

    Article  PubMed  CAS  Google Scholar 

  50. Hopf H, Grote B, Becker H, et al. Erfolgreiche Lysetherapie einer perioperativ aufgetretenen, reanimationsbedürftigen Lungenembolie mit rekombiniertem Gewebeplasminogenaktivator (rt-PA). Anaesthesist 1990; 39: 50–2

    PubMed  CAS  Google Scholar 

  51. Schlüter E, Reinhold P, Kissler GV, et al. Erfolgreiche Thrombolyse unter fortgesetzter kardiopulmonaler Rreanimation bei intraoperativer Lungenembolie. Intensivmed 1997; 34: 563–8

    Article  Google Scholar 

  52. Cyrkowicz A, Bajorek M, Nytko J, et al. Effective administration of recombinant tissue plasminogen activator (rt-PA) during resuscitation of a post partum patient with massive pulmonary embolism. Zentralbl Gynakol 1999; 121(8): 396–8

    PubMed  CAS  Google Scholar 

  53. Meier M. Erfolgreiche “single-shot” rt-PA Lysetherapie einer während Hüft-TEP-Anlage intraoperativ aufgetretenen fulminanten Lungenembolie unter fortlaufender kardiopulmonaler Reanimation. Intensivmed 1999; 36(381-84): 381–4

    Article  Google Scholar 

  54. Wittmann J, Dietz A. Lebensrettende rt-PA-Lyse bei fulminanter postoperativer Lungenembolie. Fibrinolyse 1999; 1: 8–11

    Google Scholar 

  55. Grabner C, Wahl U, Reineke H. Successful cardiopulmonary resuscitation with a high-dosage bolus injection of rt-PA after fulminant pulmonary embolism. Anästhesiol Intensivmed Notfallmed Schmerzther 2001; 36(5): 306–8

    Article  PubMed  CAS  Google Scholar 

  56. Nordmeyer U. Fulminante Lungenembolie nach Sectio Caesarea [case report]. Anaesthesist 2001; 50: 709

    Article  PubMed  CAS  Google Scholar 

  57. Jester H, Langheinrich W. The current case: streptokinase therapy in fulminant pulmonary embolism [case report]. Die gelben Hefte 1977; 2: 76

    Google Scholar 

  58. Köstering H, Möhlenhof O, Fuchs K, et al. Thrombolytische Therapie bei fulminanter Lungenembolie. Diagn Intensivtherapie 1977; 1: 1–5

    Google Scholar 

  59. Klinge U, Klosterhalfen B, Töns C, et al. Blutungskomplikation als Folge einer Boluslyse nach Reanimation [case report]. Dtsch Med Wochenschr 1991; 11: 1293

    Google Scholar 

  60. Böttiger BW, Reim SM, Diezel G. Successful treatment of a fulminant pulmonary embolism using a high-dose bolus injection of urokinase during cardiopulmonary resuscitation. Anästhesiol Intensivmed Notfallmed Schmerzther 1991; 26(1): 29–36

    Article  PubMed  Google Scholar 

  61. Borst RH, Wolf H. Rapid intravenous injection of streptokinase in a high initial dose for therapy of a fulminant pulmonary embolism. Anaesthesist 1976; 25(8): 398–401

    PubMed  CAS  Google Scholar 

  62. Schäffer R. Fulminante Lungenembolie -Ein kasuistischer Beitrag [case report]. Fortschr Anästh 1988; 2: 7

    Google Scholar 

  63. Langdon R, Swicegood W, Schwartz D. Thrombolytic therapy of massive pulmonary embolism during prolonged cardiac arrest using recombinant tissue-type plasminogen activator. Ann Emerg Med 1989; 18: 678–80

    Article  PubMed  CAS  Google Scholar 

  64. Atzinger R, Gmelin R, Weinzierl S. Lysetherapie mit rt-PA bei fulminanter Lungenembolie. Dtsch Med Wochenschr 1990; 115: 958–9

    Google Scholar 

  65. Hopf HB, Flossdorf T, Breulmann M. Rekombinanter Gewebeplasminogenaktivator (rt-PA) zur Notfallbehandlung der perioperativen lebensbedrohlichen Lungenembolie (Stadium IV). Anaesthesist 1991; 40(6): 309–14

    PubMed  CAS  Google Scholar 

  66. Trenkwalder P, Nawrath J, Lydtin H. Thrombolyse bei re-animierten Patienten mit Lungenembolie [case report]. Dtsch Med Wochenschr 1990; 115: 1534

    Article  Google Scholar 

  67. Harke H. Fibrinolysetherapie bei chirurgisch behandelten Intensivpatienten. Klin Wochenschr 1991; 69Suppl. 26: 150–6

    PubMed  Google Scholar 

  68. Siebenlist D, Gattenlöhner W. Transit-Thrombus im offenen Foramen ovale mit pulmonaler und paradoxer Embolie. Dtsch Med Wochenschr 1993; 118: 1105–9

    Article  PubMed  CAS  Google Scholar 

  69. Böttiger BW, Reim SM, Diezel G, et al. High-dose bolus injection of urokinase: use during cardiopulmonary resuscitation for massive pulmonary embolism. Chest 1994; 106(4): 1281–3

    Article  PubMed  Google Scholar 

  70. Fred HL, Yang M. Sudden loss of consciousness, dyspnea, and hypoxemia in a previously healthy young man. Circulation 1995; 91(12): 3017–9

    Article  PubMed  CAS  Google Scholar 

  71. Müller C, Axthelm EH. High-dosage systemic lysis of a fulminant pulmonary embolism in an echocardiographically recognized mobile thrombus of the right heart [case report]. Dtsch Med Wochenschr 1995; 120(50): 1758

    PubMed  Google Scholar 

  72. Onoyama Y, Minamitani M, Takeuchi H, et al. Use of recombinant tissue-type plasminogen activator to treat massive pulmonary embolism after cesarean section: a case report. J Obstet Gynaecol Res 1996; 22(3): 201–8

    PubMed  CAS  Google Scholar 

  73. Oneglia C, Rusconi C. Successful thrombolysis with rt-PA after syncope and protracted cardiopulmonary resuscitation in massive pulmonary embolism. Cardiovasc Drugs Ther 1997; 11(3): 509–11

    Article  PubMed  CAS  Google Scholar 

  74. Soltesz S, Berg K, Molter G. Erfolgreiche Thrombolyse einer fulminanten Lungenembolie unter kardio-pulmonaler Reanimation. Anaesthesist 1997; 46(10): 890–4

    Article  PubMed  CAS  Google Scholar 

  75. Kuisma M, Silfvast T, Voipio V, et al. Prehospital thrombolytic treatment of massive pulmonary embolism with reteplase during cardiopulmonary resuscitation. Resuscitation 1998; 38(1): 47–50

    Article  PubMed  CAS  Google Scholar 

  76. Schulte-Sinkus D, Standl T. Successful resuscitation after bolus injection of tissue-type plasminogen activator in emergency admission. Anästhesiol Intensivmed Notfallmed Schmerzther 1998; 33(2): 124–8

    Article  PubMed  CAS  Google Scholar 

  77. Kehoe T, DaCruz D. “Empirical” thrombolysis in catastrophic pulmonary embolism [case report]. J Accid Emerg Med 1999; 16(1): 76

    Article  PubMed  CAS  Google Scholar 

  78. Duchateau FX, Preiss V, Ricard-Hibon A, et al. Out-of-hospital thrombolytic therapy during cardiopulmonary resuscitation in refractory cardiac arrest due to acute myocardial infarction. Eur J Emerg Med 2001; 8(3): 241–3

    Article  PubMed  CAS  Google Scholar 

  79. Josephs W, Konermann M, Lenga P, et al. Therapie rekurrierenden Kammerflimmerns sowie refraktaren Pumpversagens beim akuten Myokardinfarkt durch Thrombolyse trotz Kardiokompression. Intensiv- und Notfallbehandlung 1991; 16(2): 68–71

    Google Scholar 

  80. Westhoff-Bleck M, Gulba D, Claus G, et al. Lysetherapie bei protrahierter kardiopulmonaler Reanimation: Nutzen und Komplikationen [abstract]. Z Kardiol 1991; 80Suppl. 3: 139

    Google Scholar 

  81. Tiffany PA, Schultz M, Stueven H. Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series. Ann Emerg Med 1998; 31(1): 124–6

    Article  PubMed  CAS  Google Scholar 

  82. Zahorec R. Rescue systemic thrombolysis during cardiopulmonary resuscitation. Bratisl Lek Listy 2002; 103(7-8): 266–9

    PubMed  CAS  Google Scholar 

  83. Horstkotte D, Heintzen M, Strauer B. Combined mechanical and thrombolytic reopening of the lung-stream-track with massive lung-arterial-embolism. Intensivmedizin 1990; 27: 124–32

    Google Scholar 

  84. Siebenlist D, Gattenlöhner W. Fibrinolysis with rt-PA for fulminant pulmonary thromboembolism. Intensivmedizin 1990; 27: 302–5

    Google Scholar 

  85. Hopf HB, Flossdorf T, Breulmann M. Rekombinanter Gewebeplasminogenaktivator (rt-PA) zur Notfallbehandlung der perioperativen lebensbedrohlichen Lungenembolie (Stadium IV). Anaesthesist 1991; 40(6): 309–14

    PubMed  CAS  Google Scholar 

  86. Sigmund M, Rubart M, Vom Dahl J, et al. Successful treatment of massive pulmonary embolism by combined mechanical and thrombolytic therapy. J Interv Cardiol 1991; 4(1): 63–8

    Article  PubMed  CAS  Google Scholar 

  87. Scheeren TW, Hopf HB, Peters J. Intraoperative thrombolysis with rt-PA in massive pulmonary embolism during venous thrombectomy. Anästhesiol Intensivmed Notfallmed Schmerzther 1994; 29(7): 440–5

    Article  PubMed  CAS  Google Scholar 

  88. Ruiz-Bailén M, Aguayo-de-Hoyos E, Serrano-Córcoles MC, et al. Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism: a case series. Resuscitation 2001; 51(1): 97–101

    Article  PubMed  Google Scholar 

  89. Nolan JP, de Latorre FJ, Steen PA, et al. Advanced life support drugs: do they really work? Curr Opin Crit Care 2002; 8: 212–8

    Article  PubMed  Google Scholar 

  90. Padosch SA, Motsch J, Böttiger BW. Thrombolysis during cardiopulmonary resuscitation. Anaesthesist 2002; 51: 516–32

    Article  PubMed  CAS  Google Scholar 

  91. Köhle W, Pindur G, Stauch M, et al. Hochdosierte Streptokinasetherapie bei fulminanter Lungenarterienembolie [abstract]. Anaesthesist 1984; 33: 469

    Google Scholar 

  92. Gramann J, Lange-Braun P, Bodemann T, et al. Der Einsatz von Thrombolytika in der Reanimation als Ultima ratio zur Überwindung des Herztodes. Intensiv- und Notfallbehandlung 1991; 16(3): 134–7

    Google Scholar 

  93. Klefisch F, Gareis R, Störk T, et al. Präklinische ultima-ratio Thrombolyse bei therapierefraktärer kardiopulmonaler Reanimation. Intensivmedizin 1995; 32: 155–62

    Google Scholar 

  94. Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 2002; 346(20): 1522–8

    Article  PubMed  CAS  Google Scholar 

  95. Böttiger BW, Grabner C, Bauer H, et al. Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 1999; 82(6): 674–9

    PubMed  Google Scholar 

  96. Böttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest. Curr Opin Crit Care 2001; 7(3): 176–83

    Article  PubMed  Google Scholar 

  97. Böttiger BW, Padosch SA, Wenzel V. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 2002; 347(16): 1281–2

    Article  PubMed  Google Scholar 

  98. Kürkciyan I, Meron G, Sterz F, et al. Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 2001; 51(1): 27–32

    Article  PubMed  Google Scholar 

  99. Böttiger BW, Padosch S. Thrombolysis using recombinant tissue-type plasminogen activator during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Resuscitation 2002; 53: 308–9

    Article  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the major input from our former colleague Dr Stephan A. Padosch, University of Bonn, Germany, who made important contributions in many discussions during the development of this manuscript.

F. Spöhr and B.W. Böttiger were supported, in part, by grants of the Medical Faculty of the University of Heidelberg and by the Deutsche Forschungsgemeinschaft (BO 1686/1-1).

There are no conflicts of interest directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, D-69120, Germany

    Fabian Spöhr & Bernd W. Böttiger

Authors
  1. Fabian Spöhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernd W. Böttiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabian Spöhr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spöhr, F., Böttiger, B.W. Safety of Thrombolysis during Cardiopulmonary Resuscitation. Drug-Safety 26, 367–379 (2003). https://doi.org/10.2165/00002018-200326060-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002018-200326060-00001

Keywords

Search

Navigation