Thrombolytics in ''Cardiac arrest''

[AlSomaliMD]

hye guys i really would like to post this so bad, and i cant wait for your replay specially people who work in emergency medicine and have enough experience.
We all know how dismal the resuscitation rates are in adult patients that have cardiac arrest. If a patient has V.Fib and doesn't respond to the three initial shocks or one 360j shock according to the New ACLS guidelines, the chances of survival drop off incredibly. Lidocaine, amiodarone, EPI ''Adrenaline'', high dose EPI...nothing works well once the patient has failed to respond to the three shocks in V.Fib ''or the one 360j shock''

If the patient is not in VFib, and instead is in PEA or asystole, the chances of survival are even worse.

There are some case reports documenting miraculous recoveries of patients in cardiac arrest, even in PEA arrest, when they were empirically treated early in the code with thrombolytics'' i know i couldn't believe this when i was reading this today in the annals of emergency medicine this morning''. The presumption is that those patients arrested because of a massive MI or PE.

What do people think about incorporating an empiric bolus of thrombolytics to the routine early management of patients in cardiac arrest? Is there evidence supporting this? What's to lose?

What do you all think?? please replay me and specially ppl who are emergency medicine consultants or residents ...

A. M. Al-Somali

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[Dimoak]

This article should help answer your question. As an aside, can you please refrain from making your entire posts bold with larger font sizes? It makes the posts a little annoying to read.

 

[deleted65604]

I had a hypoxic 50 year old gentleman come in with severe shortness of breath. He kept pulling the breathing mask off. I was actually holding his arm down while the nurse got IV access. I looked up, relieved we had access, and he went unresponsive. We didn't even have time to get an EKG. PEA rhythm. Wife had told the paramedics that he was 2 weeks post-op from a hip replacement and that she was worried that he had a PE.

I lysed him and he still died.

That conversation sucked. "Yes, I know he looked OK when he left you, but he didn't do so hot."

Autopsy showed MI, no evidence of PE.

I'd have to have a high suspicion of PE or NSTEMI to want to lyse them. Otherwise, I'd just go through the ACLS motions a few rounds and call it. I guess it depends on age and comorbidities. The gentleman I lysed was fairly young, looked to be in fairly good shape. Once he was intubated, he was satting fine, so I thought that there was a decent hope of intact neurologic survival and a meaningful existance if he made it. With an old person with lots of medical problems, I always (guiltily) hope that they don't get vitals back. I always think, "You and your family wouldn't want your brain-dead body rotting away in some nursing home. Walk to the light. Don't look back. Death is not the enemy."