• M Confalonieri and P C Gazzaniga.
• Divisione di Pneumologia, Ospedale Maggiore, Crema, Cremona.
• Recenti Prog Med. 1993 Sep 1; 84 (9): 608-14.

AbstractTreatment of acute myocardial infarction with intravenous thrombolytic agents improves survival and limits the infarct's size. Despite its proved efficacy, thrombolytic therapy is currently used for only a minority of patients with acute myocardial infarction. Because of the possibility of significant haemorrhagic complications, certain groups of patients traditionally have been excluded from receiving this therapy. Patients with acute myocardial infarction following prolonged cardiopulmonary resuscitation are often considered ineligible for thrombolytic therapy, because an higher bleeding risk. The Authors report the case of a 52 yr old man with primary ventricular fibrillation and acute myocardial infarction treated with streptokinase i.v. after having a prolonged (20 min.) cardiopulmonary resuscitation. The patient did not report gross trauma and recovered to a completely functional status without any relevant bleeding complication. To date, only few case reports exist on thrombolysis in patients with recent prolonged resuscitation, and most of them are favourable. The literature on thrombolytic therapy in acute myocardial infarction following cardiopulmonary resuscitation is reviewed. Recent (< 2 w) prolonged (< 1 min.) cardiopulmonary resuscitation, per se, should not be regarded as absolute contraindication for thrombolytic therapy in patients with acute myocardial infarction if gross trauma and oldest age are absent. Prospective controlled studies are necessary to remove definitively this contraindication for thrombolysis.

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