Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation

Objective: To evaluate the efficacy and safety of systemic thrombolysis adm inistered to resuscitated patients after cardiac arrest (CA) due to an acut e myocardial infarction (AMI), through a study of their mortality and haemo rrhagic complications. Design: We studied a. retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "An alysis of Delay in AMI" (ARIAM). Setting: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish h ospitals. Patients and participants: The study period was from 1 January 1995 to 1 Ja nuary 2000, when 22,922 patients were included in the ARIAM database regist er; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. Measurements and results: Of the 303 patients studied, 228 were male (75.25 %); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was admin istered to 67 patients (group I) and the remaining 236 patients were manage d without this treatment (group II). The ICU/CCU mortality rate of the seri es was 39.93% (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (209 patients) (P < 0.00001)., Group I required les s mechanical ventilation (group I, 42.85% vs group II, 80.76%; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0. 0001). Group I also showed a lower incidence of cardiogenic shock (14.28% v s 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% us 39.89% P = 0.006) . There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an inde pendent variable that protected against mortality, Conclusions: The administration of thrombolysis to patients with AMI who re quire resuscitation may be efficacious in reducing mortality and is safe, w ith no increase in haemorrhagic complications.