Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Wednesday, January 6, 2016

Pushing TPA

emDocs - Jan 5, 2016 - Authors: Sekaran D, Scoccimarro A and Waseem M
Edited by: Robertson J and Koyfman A
Cardiac arrest is a problem that is seen frequently in emergency departments. Estimates show that 155,000 patients have an out-of-hospital cardiac arrest annually, with a survival rate of less than 10%. 70% of these cases are caused by myocardial infarction and pulmonary embolism (PE). Given the pro-thrombotic state caused by both of these pathologies, the use of a thrombolytic drug seems to be a reasonable choice in the coding patient.2 However, thrombolytic medications should always be administered with caution because of the high risk of bleeding. While there is some evidence to justify their administration to patients with a ST elevation MI (STEMI) or unstable patients with PE, the data from code situations with ongoing cardiopulmonary resuscitation (CPR) is limited.
In a code situation, a fibrinolytic can theoretically be given to remove the causative factor and reduce microvascular ischemia. A two-fold risk in bleeding should be expected.
Although CPR is currently listed as a relative contraindication for TPA, prior studies do not appear to show a correlation between prolonged CPR and increased bleeding following the administration of fibrinolytic.
One should always consider bedside ultrasound as a diagnostic adjunct in cardiac arrest.
Evidence and guidelines recommend administering fibrinolytic to any unstable patient with PE, which includes patients in cardiac arrest.
Administering a thrombolytic in a cardiac arrest from MI remains controversial. The benefits may outweigh the bleeding risks in the context of a STEMI. However, obtaining this diagnosis in a code situation is difficult. Empiric administration may lead to adverse outcomes if there is a non-thrombotic cause of arrest. Until further evidence is obtained, each event should be considered on an individual case by case basis."