CHAPTER 32 tPA in PEA Cardiac Arrest

Tissue Plasminogen Activator in Cardiac Arrest with Pulseless Electrical Activity

Abu-Laban RB, Christenson JM, Innes GD, et al. N Engl J Med. 2002;346(20):1522–1528

BACKGROUND

Out-of-hospital cardiac arrest accounts for 250,000 deaths annually with pulseless electrical activity (PEA) the presenting rhythm in 20% of arrests. The survival rate to discharge in these cases is 4%. Coronary and pulmonary thromboembolism frequently present with PEA as the initial rhythm. It was postulated that because fibrinolytics show marked benefits in both acute MI and PE they may improve the low survival rates in PEA arrest. Several case series and nonrandomized trials had lent support to this idea, and this study was designed to more rigorously assess these claims.

OBJECTIVES

To evaluate the effect of tPA during CPR in adults with undifferentiated PEA (i.e., with an unknown or presumed cardiovascular cause) that was not responsive to initial therapy.

METHODS

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