Präklinische Thrombolyse Als Ultima Ratio Bei Kardiopulmonaler Reanimation

The outcome of a cardiac arrest due to massive pulmonary embolism or myocardial infarction is still dismal. Recently thrombolytic therapy is used even for out-of-hospital resuscitation. Thrombolysis can both eliminate dissiminated clots in small vessels and improve the microcirculatory cerebral reperfusion after cardiac arrest. Therefore the thrombolysis, as proven by experiments on animals, can prevent the growth of a micro-thrombus or eliminate the thrombus, as well as reduce the perfusion dysfunction. The use of thrombolytic therapy contains a high risk of severe haemorrhage,, particularly intracerebral bleeding. Out-of-hospital use of thrombolytic therapy was only recommended as a rescue procedure as a last resort before terminating resuscitation. The following case report describes the successful preclinical use of a thombolysis with Reteplase after resuscitation lasting 60 minutes due to myocardial infarction. Despite the appearance of liver-haematoma this patient was discharged from hospital without neurological deficiencies.