Don’t have your cardiac arrest at home ▸

Patients who suffer from out of hospital cardiac arrest generally have a low chance of survival. This large study examined whether the outcome of out of hospital arrest is influenced by the patient’s location. According to the Swedish cardiac arrest registry, ambulance crews attended and attempted to resuscitate 24 630 out of hospital cardiac arrest patients between 1990 and 1999. Of these, 66% took place at home. Patients who suffered cardiac arrest at home were generally older, more likely to be female, less often had a witnessed event, less often had bystander CPR, were less often in VF, and had a longer time interval between collapsing and trained assistance arriving. Not surprisingly, given these data, patients who arrested elsewhere had a greater chance of arriving at hospital alive (19.4% v 11.3% p<0.0001) and were more likely to be alive at one month (6.2% v 1.7% p<0.0001). Out of hospital cardiac arrest remains a challenge, particularly when in occurs at home.

Reperfusion therapy in acute myocardial infarction: a role for IIb/IIIa receptor antagonists? ▸

Myocardial reperfusion remains the cornerstone of early management of acute myocardial infarction. The clinical benefits of using aspirin in the acute setting has led to the belief that fibrinolytic therapy may be improved by adjunctive use of more potent platelet inhibitors. In small pilot trials, combined use of IIa/IIIb inhibitors and fibrinolytic therapy increased the speed and completeness of recanalisation of the infarcted vessel and reduced reocclusion. There was also evidence to suggest that doses of reteplase could be reduced by half when given in combination with abciximab.

It was therefore with surprise that when tested in the large (16 588 patients) GUSTO V trial, this strategy resulted in …