Are Thrombolytics Useful in Out-of-Hospital Cardiac Arrest?

Out-of-hospital cardiac arrest (OHCA) is a global health concern with persistently low survival rates. The most common cause of OHCA is coronary heart disease, often leading to abnormal heart rhythms such as refractory ventricular fibrillation (VF). Thrombolytic therapy's role in OHCA, especially in cases secondary to acute myocardial infarction (AMI), remains uncertain. We present a case of a previously healthy 43-year-old male patient who presented in asystole to the emergency department (ED), following a witnessed cardiac arrest. The patient was intubated and advanced cardiac life support (ACLS) initiated. Systemic thrombolytic (alteplase 100 mg) was administered intravenously 19 minutes into his ED presentation and return of spontaneous circulation (ROSC) was achieved at minute 47 with electrocardiogram (EKG) showing intraventricular conduction delay. The patient was transported to the catheterization laboratory and was found to have a total occlusion of the left obtuse margin artery and a drug eluting stent was deployed within 18 minutes of ROSC. The patient was extubated on day 3 with normal neurological examination and was discharged from the hospital 22 days after admission. This case builds on the previous literature that systemic thrombolysis may be of added value when used in resuscitation as a salvage therapy in OHCA patients, potentially by lysing coronary thrombi and improving perfusion before PCI. Further studies are needed to shed the light on this important aspect of resuscitation management.