PDF(Pubmed)
Abstract：
Tissue plasminogen activator (TPA) is indicated as an empiric therapy for refractory out-of-the-hospital cardiac arrest for suspected pulmonary embolism and myocardial infarction. Intracranial hemorrhage following TPA administration is a rare complication resulting in increased morbidity and mortality. A history of intracranial bleed, oral anticoagulant use prior to hospital admission, low body weight, and unstable hypertension with blood pressure above 180/110 mmHg at the time of presentation are associated with intracranial bleeding following tPA administration. Dedicated imaging including a Computed Tomography of the head without contrast, while feasible for patients presenting with acute stroke, is impractical in the setting of cardiac arrest. Here we report a case of 66 years old patient who presented in context of refractory cardiac arrest with recurrent PEAs with interval return of spontaneous circulation (ROSC) and was given tPA with eventual ROSC. He was subsequently found to have both a subarachnoid and intraventricular hemorrhage.
摘要：
组织纤溶酶原激活剂（TPA）被认为是难治性院外心脏骤停的经验性治疗，用于怀疑肺栓塞和心肌梗塞。TPA给药后的颅内出血是导致发病率和死亡率增加的罕见并发症。有颅内出血史,入院前使用口服抗凝剂，体重低,出现时血压高于180/110mmHg的不稳定型高血压与tPA给药后颅内出血有关。专用成像，包括没有对比的头部计算机断层扫描，虽然对于急性中风患者是可行的，在心脏骤停的情况下是不切实际的。在这里，我们报告了一例66岁的患者，该患者在难治性心脏骤停的情况下出现了反复的PEA，并有自发循环（ROSC）的间歇恢复，并接受了tPA和最终的ROSC。随后发现他患有蛛网膜下腔出血和脑室内出血。
