Tissue Plasminogen Activator in Out-of-Hospital Cardiac Arrest with Asystole

This study was conducted to determine whether administration of recombinant tissue plasminogen activator in out-of-hospital cardiac arrest with asystole as the initial rhythm improves post-resuscitation outcome. A retrospective chart review of 177 patients with out-of-hospital cardiac arrest who underwent attempted resuscitation by the emergency medical service was performed for a six-year observation period. A total of 34 patients received thrombolytic therapy during resuscitation and were compared to 102 controls, closely matched according to arrival status. Administration of thrombolytics was optional. Return of spontaneous circulation occurred in 23 patients in the treatment group (68% vs. 33% in controls; p=0.001). Ten patients survived the first 24 hours (29% vs. 14% in controls; p=0.038), while four survived more than ten days (12% vs. 5% in controls; p=0.163). Three patients from the treatment group were ultimately discharged from hospital (9% vs. 3% in controls; p=0.570). Generally, the outcome of patients with asystole as the initial rhythm in cardiac arrest is poor. Thrombolytic therapy, however, may substantially improve frequency of return of spontaneous circulation and increase 24-hour survival in patients with asystole in out-of hospital cardiac arrest.