Advertisement

Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Prolonged external cardiac massage is often regarded as a contraindication for thrombolytic therapy because of the risk of fatal hemorrhage. The influence of cardiopulmonary resuscitation on complications of thrombolytic bleeding was assessed analyzing data of all patients with myocardial infarction admitted to our clinic during the 10-year period between 1978 and 1987. From the total of 2,147 patients with acute myocardial infarction, 590 received thrombolytic therapy (intracoronary in 229, intravenous in 400). Of these, 43 patients underwent prolonged cardiopulmonary resuscitation and received thrombolysis within a time interval of <24 hours.
      In 21 patients, resuscitation was performed within a short period of time (5 minutes to 20 hours) after thrombolysis (10 intracoronary, 10 intravenous, 1 intravenous + intracoronary) had been initiated; 9 of these patients survived (43%). In the other 22 patients, thrombolytic therapy was initiated during ongoing resuscitation (n = 6: intravenous in 5, intravenous + intracoronary in 1) or in the early phase (10 to 120 minutes) after successful resuscitation (n = 16: intracoronary in 10, intravenous in 4, intravenous + intracoronary in 2). From this group, 14 patients survived (in-hospital mortality 36%). The mean duration of cardiopulmonary resuscitation was 36 ± 32 minutes (range 4 to 120). Autopsy studies were performed in 16 of 20 deceased patients. Bleeding complications occurred in 8 of 43 patients. No case of bleeding was directly related to cardiocompression despite the often traumatic procedure with rib fractures verified in 17 patients. There was no difference in the rate of bleeding complications for patients with (n = 43) and without (n = 547) resuscitation (18.6 vs 16.1%; chi-square = 0.34, p = not significant).
      Thus, in patients with acute myocardial infarction, preceding or ongoing external cardiac massage, per se, should not be regarded as contraindication for thrombolytic therapy.
      To read this article in full you will need to make a payment

      References

      1. ACC/AHA Guidelines for the early management of patients with acute myocardial infarction.
        Circulation. 1990; 82: 664-706
        • Kennedy JW
        • Ritchie JL
        • Davies KB
        The Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction.
        N Engl J Med. 1985; 312: 1073-1078
        • Schröder R
        • Neuhaus KL
        • Leizorovicz A
        • Linderer T
        • Tebbe U
        • The I.S.A.M Study Group
        A prospective trial of intravenous streptokinase in acute myocardial infarction. Mortality, morbidity, and infarct size at 21 days.
        N Engl J Med. 1986; 314: 1465-1472
        • Gruppo italiano per lo studio della streptochinasi della infarcto miocardio (GISSI)
        Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction.
        Lancet. 1986; 1: 397-401
        • ISIS-2, collaborative group
        Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction.
        Lancet. 1988; 2: 349-360
        • Neuhaus KL
        • Tebbe U
        • Gottwik M
        • Weber M
        • Feuerer W
        • Nieterer W
        • Haeper W
        • Praetorius F
        • Grosser KD
        • Huhmann W
        • Hoepp HW
        • Abber G
        • Sheikhzadeh A
        • Schneider B
        Intravenous recombinant tissue plasminogen activator (rt-PA) and urokinase in acute myocardial infarction: results of the German activator urokinase study (GAUS).
        J Am Coll Cardiol. 1988; 12: 581-587
        • Yusuf S
        • Collins R
        • Petro R
        Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials.
        Eur Heart J. 1985; 6: 556-585
        • Mueller HS
        • Rao AK
        • Forman SA
        Thrombolysis in myocardial infarction (TIMI): comparative studies of coronary reperfusion and systemic fibrinogenolysis with two forms of recombinant tissue-type plasminogen activator.
        J Am Coll Cardiol. 1987; 10: 479-490
        • Haugeberg G
        • Benarjie V
        • Dickstein K
        Fatal intrathoracic haemorrhage after cardiopulmonary resuscitation and treatment with streptokinase and heparin.
        Br Heart J. 1989; 62: 157-158
        • Josephs W
        • Odenthal HJ
        • Lenga P
        • Wiechmann HW
        Erfolgreiche Reanimation durch thrombolytische Therapie unter maschineller Kardiokompression bei akutem Verschluss des linken Hauptstammes.
        Intensivmed. 1989; 26: 268-271
        • Scholz KH
        • Herrmann CH
        • Tebbe U
        • Reiss N
        • Neuhaus KL
        • Kreuzer H
        Decline of in-hospital mortality after acute myocardial infarction during the last ten years: result of acute intervention?.
        Dtsch Med Wochenschr. 1988; 113: 1305-1311
        • Neuhaus KL
        • Tebbe U
        • Sauer G
        • Kreuzer H
        • Koestering H
        High dose of intravenous streptokinase in acute myocardial infarction.
        Clin Cardiol. 1983; 6: 426-434
        • Rentrop KP
        • Blanke H
        • Karsch KR
        • Wiegand V
        • Koestering H
        • Oster H
        • Leitz K
        Acute myocardial infarction: intracoronary application of nitroglycerin and streptokinase.
        Clin Cardiol. 1979; 2: 354-363
        • Renkes-Hegendoerfer U
        • Herrmann K
        Successful treatment of a case of fulminant massive pulmonary embolism with streptokinase.
        Anaesthesist. 1974; 23: 500-501
        • Borst RH
        • Wolf H
        Rapid intravenous injection of streptokinase in a high initial dose for therapy of a fulminant pulmonary embolism.
        Anaesthesist. 1976; 25: 398-401
        • Koestering H
        • Moehlenhof O
        • Fuchs K
        • Amsel M
        Thrombolytische Therapie bei fulminanter Lungenembolie.
        Diagn Intensivtherapie. 1977; 1: 1-5
        • Flügel H
        • Bartels O
        • van der Rode J
        Behandlung der fulminanten Lungenembolie unter Reanimationsbedingungen.
        Fortschr Med. 1978; 96: 639-642
        • Unseld H
        • Hildebrand MF
        • Hensius P
        Streptokinase bei Lungenembolie mit Herz-Kreislaufstillstand.
        Anaesthesist. 1978; 27: 333-335
        • Wester HA
        • Orellano L
        • Fenyes-Bellmann J
        • Hügel E
        • Kirchhoff PG
        Successful treatment of a massive pulmonary embolism after 90-minute external heart massage.
        Dtsch Med Wochenschr. 1986; 111: 1151-1154
        • Gramann J
        • Lange-Braun P
        • Hochrein H
        Einsatzmöglichkeiten der Thrombolyse in der Reanimation.
        Intensivmed. 1988; 25: 425-429
        • Siebenlist D
        • Gattenlöhner W
        Kurzzeitlyse mit rt-PA bei fulminanter Lungenembolie.
        Intensivmed. 1990; 27: 302-305
        • Horstkotte D
        • Heintzen MP
        • Strauer BE
        Kombinierte mechanische und thrombolytische Wiedereröffnung der Lungenstrombahn bei massiver Lungenarterienembolie mit kardiogenem Schock.
        Intensivmed. 1990; 27: 124-132
        • Scholz KH
        • Hilmer T
        • Schuster S
        • Wojcik J
        • Kreuzer H
        • Tebbe U
        Thrombolysis in resuscitated patients with pulmonary embolism.
        Dtsch Med Wochenschr. 1990; 115: 930-935
        • Jaeger A
        • Macharoui A
        • Melz F
        • Scholz-Jaeger A
        • Straub H
        • Barmeyer J
        Systemic fibrinolysis after resuscitation or temporary transvenous pacing.
        Dtsch Med Wochenschr. 1990; 115: 1009-1013
        • Tenaglia AN
        • Califf RM
        • Candela RJ
        • Kereiakes DJ
        • Berrios E
        • Young SY
        • Stack RS
        • Topol EJ
        Thrombolytic therapy in patients requiring cardiopulmonary resuscitation.
        Am J Cardiol. 1991; 68: 1015-1019