tailieunhanh - Báo cáo y học: "Thrombolysis during out-of-hospital cardiac arrest: a lesson in the law of diminishing returns"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Thrombolysis during out-of-hospital cardiac arrest: a lesson in the law of diminishing returns. | Dargin and Emlet Critical Care 2010 14 304 http content 14 2 304 CRITICAL CARE JOURNAL CLUB CRITIQUE L Thrombolysis during out-of-hospital cardiac arrest a lesson in the law of diminishing returns James M Dargin1 and Lillian L Emlet2 University of Pittsburgh Department of Critical Care Medicine Evidence-Based Medicine Journal Club edited by Eric B Milbrandt Expanded Abstract Citation Bottiger BW Arntz HR Chamberlain DA Bluhmki E Belmans A Danays T Carli PA Adgey JA Bode C Wenzel V Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 2008 359 2651-2662 1 . Background Approximately 70 of persons who have an out-of-hospital cardiac arrest have underlying acute myocardial infarction or pulmonary embolism. Therefore thrombolysis during cardiopulmonary resuscitation may improve survival. Methods Objective To determine whether thrombolysis with the use of tenecteplase during cardiopulmonary resuscitation can improve survival in adults with witnessed out-of-hospital arrest of presumed cardiac origin. Design Prospective randomized double-blind placebo-controlled multicenter trial. Setting 66 European emergency medical-service systems. Subjects 1050 adult patients with witnessed out-of-hospital cardiac arrest. Intervention We randomly assigned adult patients with witnessed out-of-hospital cardiac arrest to receive tenecteplase or placebo during cardiopulmonary resuscitation. Adjunctive heparin or aspirin was not used. Outcomes The primary end point was 30-day survival the secondary end points were hospital admission return of spontaneous circulation 24-hour survival survival to hospital discharge and neurologic outcome. Results After blinded review of data from the first 443 patients the data and safety monitoring board recommended discontinuation of enrollment of asystolic patients because of low survival and the protocol was amended. Subsequently the trial was terminated prematurely for futility after .