Successful Resuscitation of Cardiac Arrest with Concurrent Intravenous Thrombolysis during Cardiopulmonary Resuscitation

Summary

This case report describes the successful management of a patient with acute myocardial infarction complicated by cardiac arrest, who underwent cardiopulmonary resuscitation and received intravenous thrombolysis during resuscitation. The case highlights the potential feasibility and clinical relevance of thrombolysis administered concurrently with resuscitation efforts.

Abstract

Thrombolytic therapy has long been considered a relative contraindication during cardiopulmonary resuscitation (CPR), mainly due to concerns about fatal bleeding complications. However, in patients with acute myocardial infarction (AMI), untreated coronary thrombosis remains a major cause of unsuccessful resuscitation. We report the case of a 66-year-old man with a history of hypertension and cerebral infarction who presented with chest pain, subsequently developed cardiac arrest, and was successfully resuscitated after concurrent intravenous thrombolysis during CPR. The patient collapsed after 1 h of persistent chest pain. Emergency medical services initiated advanced life support, including chest compressions, airway management, and adrenaline administration. On hospital arrival, the patient experienced recurrent cardiac arrest. Despite prolonged resuscitation attempts, spontaneous circulation could not be sustained. Following family consent, intravenous thrombolytic therapy with heparin and alteplase was administered during ongoing CPR. Following thrombolytic therapy, sustained return of spontaneous circulation was achieved. Coronary angiography confirmed right coronary artery thrombosis, and percutaneous coronary intervention with stent implantation was performed. The patient was stabilized with temporary pacing, transferred to the intensive care unit, and later discharged with full neurological recovery. This case suggests that intravenous thrombolysis administered during CPR for AMI-related cardiac arrest may be a feasible rescue strategy when conventional measures are insufficient. Early thrombolytic decision-making, high-quality CPR, and multidisciplinary collaboration contributed to the favorable outcome. This report adds to the growing body of evidence regarding the potential role of thrombolysis in selected resuscitation scenarios.

Introduction

Acute myocardial infarction (AMI) is among the most common etiologies of sudden cardiac arrest (CA) and accounts for a substantial proportion of cardiovascular mortality worldwide^1,2. Despite continuous improvements in prehospital emergency care, defibrillation techniques, and coronary interventions, survival after out-of-hospital CA remains low, with neurologically intact discharge rates reported to be less than 10%^3,4. Cardiopulmonary resuscitation (CPR) constitutes the cornerstone of emergency management, providing temporary perfusion to vital organ....

Protocol

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Yantaishan Hospital. Written informed consent for publication was obtained from the patient’s family. This protocol narrates the real-world clinical course of a 66-year-old man with inferior ST-segment elevation myocardial infarction (STEMI) who suffered recurrent cardiac arrest (CA). Intravenous thrombolysis with alteplase was administered during ongoing cardiopulmonary resuscitation (CPR), followed by definitive revascularization with PCI. Timings, doses, monitoring, and decision points reflect the actual care pathway in this case.

Results

Application of the above management strategy resulted in successful resuscitation and full clinical recovery. On initial prehospital assessment, continuous electrocardiographic monitoring demonstrated acute inferior ST-segment elevation myocardial infarction, confirming the diagnosis of STEMI (Figure 1). Despite fluid resuscitation and vasopressor therapy, the patient experienced cardiac arrest with asystole. After approximately 25 min of advanced life support, ROSC was achieved, although pr.......

Discussion

This case demonstrates the successful use of systemic thrombolysis administered during ongoing cardiopulmonary resuscitation (CPR) in a patient with an acute inferior ST-segment elevation myocardial infarction complicated by recurrent cardiac arrest. Despite prolonged resuscitation efforts, sustained ROSC was achieved after thrombolysis, suggesting a temporal association between reperfusion and restoration of effective circulation, rather than a definitive causal relationship. Subsequent coronary angiography confirmed ri.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Alteplase (rt-PA)	Boehringer Ingelheim	NDC 00597-0050-54	15 mg IV bolus + 85 mg infusion protocol; systemic thrombolysis
Arterial blood gas analyzer	Radiometer	ABL800 FLEX	Point-of-care ABG test
Atropine injection	Fresenius Kabi	NDC 63323-039-01	1 mg/amp; used for bradycardia/asystole
Capnography monitor	Medtronic	CS20	Verification of intubation and CPR quality
Coronary angiography system	Siemens Healthineers	Artis zee 2 ceiling	Cath lab PCI and angiography system
Coronary balloon catheter	Medtronic	NC Trek 1012560	Balloon dilatation prior to stent implantation
Coronary stent	Abbott	Xience Sierra RX4180	Drug-eluting stent; deployed in RCA
Defibrillator/monitor	Philips	M3535A	Multiparameter monitor with ECG/defibrillation
Diazepam injection	Roche	NDC 50419-460-05	10 mg/2 mL; sedation for ventilator synchrony
Dopamine hydrochloride injection	Fresenius Kabi	NDC 63323-082-10	200 mg/20 mL; vasopressor infusion
ECG machine (12-lead)	Nihon Kohden	CardioFax GEM 9022	Standard 12-lead ECG monitoring
Echocardiography system	GE Healthcare	H45052AA	Bedside echo; EF and wall motion assessment
Endotracheal tube	Teleflex	REF 100/185	ID 7.0–8.0 mm; airway intubation
Epinephrine injection	Hospira	NDC 00409-4927-10	1 mg/amp; administered every 3–5 min during CPR
Heparin sodium injection	Pfizer	NDC 00409-2721-01	5000 U/amp; IV bolus before thrombolysis
Infusion pump	B. Braun	8713050U	Continuous infusion of rt-PA and vasopressors
Shenfu injection	Livzon	NDC 69281-123-10	100 mL; adjunctive circulatory support
Sodium bicarbonate injection	Baxter	NDC 0338-0517-10	5% 125 mL; correction of metabolic acidosis
Supraglottic airway (LMA)	Ambu	322100000	Size 4/5; initial airway management
Temporary pacing lead	Medtronic	6416	Transvenous pacing catheter post-PCI