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Notes from Cardiac Arrest and the Role of Thrombolytic Agents  added 12/28/00

Annals of Emergency Medicine  May 2000 pg 472-479

Abstract:
"Thrombolytic agents may have clinically significant beneficial effects in cardiac arrest. The application of thrombolytic drugs in the setting of current and antecedent cardiopulmonary resuscitation is well documented; however, it has not been systematically studied nor has it been widely considered. We provide a literature review of thrombolytic agents and cardiopulmonary resuscitation to discuss the need for randomized controlled trials and the possibility of benefits in acute resuscitation."

"We can now expect 92% to 93% of all patients experiencing out-of-hospital cardiac arrest to die and 2% to 3% more to survive with moderate to sever neurolgic impairment."

This paper reviews 9 articles

"Although the frequency of side effects of thrombolytic agents is low, these side effects can be devastating."

The article speculates that conventional EMS vehicles will not have these agents, as they will be too expensive, rarely used, require re-stocking, and require training.

"Ideally, thrombolysis as a modality in cardiac arrest may be most fitting in certain subgroups and not in an undifferentiated population.  For instance, patients with likely or confirmed PE {pulmonary embolus} causing arrest are excellent candidates for thrombolytic bolus."

Article concludes: more research is needed

Skyaid comment: might be cost effective on future Skycar, but probably will require good diagnosis, perhaps by telemedicine.