Do you administer thrombolytics during cardiac arrest? Or maybe you don't believe in thrombolytics, but are totally down with fibrinolytics during arrest. Who do you administer them to and which one do you use? I give you my own circuitous ramblings on the topic in this episode.
Who Should Get Lysed?
SR/MA
RCT Mentioned
- TROICA (19092151)
Studies not Included in that SR/MA
- PEAPETT (27422214) (RebelM Review)
- French Registry Trial (31381884)
What Lytic?
Full Dose Tenecteplase via Manufacturer Recs or 50 mg of Alteplase by IV Push over ~60 seconds (29880524)
How Long Should You Keep Going?
- 30-60 minutes after lytic administration
Update
Evidence on the lack of utility of the RV during arrest to dx PE
Now on to the Podcast…
Additional New Information
More on EMCrit
Podcast 191 – Cardiac Arrest Update(Opens in a new browser tab)
EMCrit 354 – Reduced-Dose Systemic Peripheral Fibrinolysis in Massive Pulmonary Embolism
Additional Resources
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Do you still do the 50 mg alteplase dose in cardiac arrest stemi? Or do you do the AHA 50 mg bolus followed by infusions of 15mg and 35mg?
50 mg followed by cath lab
Hey Scott, What does “continued resuscitation” mean in your shop? Are you continuing to give Epi every 5 and doing rhythm checks after administering lytics?
Hi Scott, do you happen to have any good references confirming the utility (or lack there of, as you suggest) of RV morphology during cardiac arrest as it relates to PE? I only know of one paper out of UCSD on the overall high prevalence of RV dysfunction peri-arrest and some data out of Denmark on animal models.
http://www.ultrasoundpodcast.com/wp-content/uploads/2019/08/Document-for-RHS-in-arrest-podcast-to-upload.pdf
Very much appreciate that, thank you! If interested, to add to that list is the UCSD article I mentioned: https://www.ncbi.nlm.nih.gov/pubmed/27079665
Scott, im writing from Trujillo – Perú.
I want to ask you maybe want to come to my country for a congress….
correamezajorge@gmail.com
Hi Scott,
do you give the patient anticoagulation (e.g. UFH) during CPR after the application of thrombolysis?
I could not find anything conclusive on the issue, rather some sidenotes, that in some studies they gave anticoagulants as well as thrombolysis.
Even though it would make pharmacological sense (you dissolve a clot and want it to NOT form again), there is no recommendation I could find and I have to ask myself about the increased bleeding risk vs benefit (which we know about from studies done on lysis in MI combined with Heparin)…
Thanks a lot!