Carrillo-Esper R, Díaz-Carrillo MA, Pérez-Calatayud ÁA, Zepeda-Mendoza AD

Language: Spanish
References: 17
Page: 727-733
PDF size: 516.40 Kb.

ABSTRACT

The effectiveness in cardiopulmonary resuscitation as proposed by the American Heart Association (AHA) Guidelines has increased the survival rate in patients with cardiac arrest, besides there is a rise in the presence of post-resuscitation disease with hematologic dysfunction requiring a dynamic monitoring. We report the case of a 71-year-old female patient with diabetes and systemic arterial hypertension with cardiac arrest. We initiated maneuvers recommended in the algorithms of de AHA and we obtained return to spontaneous circulation. During cardiopulmonary resuscitation maneuvers we obtained a thromboelastography curve which showed a hyperfibrinolytic pattern. In the initial phase of the postcardiac arrest syndrome we obtained again a thromboelastography curve, which presented a prothrombotic state. The severe coagulopathy that presents in postcardiac arrest syndrome, from a hyperfibrinolytic to a prothrombotic state, is the reason why we recommend the follow up and evaluation of coagulation using a thromboelastograph analyzer, which will help to have a better understanding of the therapeutic conduct in relation of thromboprophylaxis, anticoagulation and in special cases fibrinolytic therapy.

REFERENCES

1. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-556.

2. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999;341:871-878.

3. McEvoy MD, Field LC, Moore HE, Smalley JC, et al. The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation 2014;85:82-87.

4. Neumar RW, Nolan JP, Adrie C, Aibiki M, et al. Postcardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 2008;118:2452-2483.

5. Luddington RJ. Thrombelastography/thromboelastometry. Clin Lab Haematol 2005;27:81-90.

6. Jackson GN, Ashpole KJ, Yentis SM. The TEG vs the ROTEM thromboelastography/thromboelastometry systems. Anaesthesia 2009;64:212-215.

7. Böttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest. Curr Opin Crit Care 2001;7:176-183.

8. Gando S. Microvascular thrombosis and multiple organ dysfunction syndrome. Crit Care Med 2010;38:35-42.

9. Fischer M, Hossmann KA. No-reflow after cardiac arrest. Intensive Care Med 1995;21:132-141.

10. Böttiger BW, Krumnikl JJ, Gass P, Schmitz B, et al. The cerebral ‘no-reflow’ phenomenon after cardiac arrest in rats--influence of low-flow reperfusion. Resuscitation 1997;34:79-87.

11. Köhle W, Pindur G, Stauch M, Rasche H. Hochdosierte Streptokinasetherapie bei fulminanter Lungenarteriembolie. Anaesthesist 1982;33:469.

12. Scholz KH, Hilmer T, Schuster S, Wojcik J, et al. Thrombolysis in resuscitated patients with pulmonary embolism. Dtsch Med Wochenschr 1990;115:930-935.

13. Gramann J, Lange-Braun P, Bodemann T, Hochrein H. Deir Einsatz von Thormbolytika in der Reanimation als Ultima ratio zur Überwindung des Herztodes. Intesivund Notfallbehandlung 1991;16:134-137.

14. Scholz KH, Tebbe U, Herrmann C, Wojcik J, et al. Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 1992;69:724-728.

15. Kürkciyan I, Meron G, Sterz F, Janata K, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160:1529-1535.

16. Kleiner DM, Ferguson KL, King K, Bozeman WP. Empiric Tecneteplase use in cardiac arrest refractory to standard advanced cardiac life support interventions. Circulation 2003;108:318-319.

17. Fatovich DM, Dobb GJ, Clugston RA. A pilot randomised trial of thrombolysis in cardiac arrest (The TICA trial). Resuscitation 2004;61:309-313.