Thrombolysis during out-of-hospital cardiac arrest a lesson in the law of diminishing returns 英文参考文献.docVIP

Dargin and Emlet Critical Care 2010,14:304 /content/14/2/304 JOURNAL CLU B CRITIQUE Thrombolysis during out-of-hospital cardiac arrest: a lesson in the law of diminishing returns James M Dargin and Lillian L Emlet 1 2 University of Pittsburgh Department of Critical Care Medicine: Evidence-Based Medicine Journal Club, edited by Eric B Milbrandt Expanded Abstract Citation B?ttiger BW, Arntz HR, Chamberlain DA, Bluhmki E, Belmans A, Danays T, Carli PA, Adgey JA, Bode C, Wenzel V: Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 2008, 359:2651-2662 [1]. Background Approximately 70% of persons who have an out-of-hospital cardiac arrest have underlying acute myocardial infarction orpulmonary embolism. Therefore, thrombolysis during cardiopulmonary resuscitation may improve survival. Methods Objective: To determine whether thrombolysis with the use of tenecteplase during cardiopulmonary resuscitation can improve survival in adults with witnessed out-of-hospital arrest of presumed cardiac origin. Design: Prospective, randomized, double-blind, placebo-controlled, multicenter trial. Setting: 66 European emergency medical-service systems. Subjects: 1050 adult patients with witnessed out-of-hospital cardiac arrest. Intervention: We randomly assignedadult patients with witnessed out-of-hospital cardiac arrestto receive tenecteplase or placebo during cardiopulmonary resuscitation.Adjunctive heparin or aspirin was not used. Outcomes: The primary end point was 30-day survival; the secondary end points were hospitaladmission, return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and neurologic outcome. Results After blinded review of data from the ?rst 443 patients,the data and safety monitoring board recommended discontinuationof enrollment of asystolic patients because of low survival, and the protocol was amended. Subsequently, the trial was terminat