MANAGEMENT OF CARDIAC ARREST: THROMBOLYSIS IS (NOT) FOR CLOTS

This multicentre double-blind controlled trial randomised adult patients following witnessed cardiac arrest in the prehospital setting to treatment with tenecteplase or placebo. The trial was terminated early following interim analysis after 525 patients had been recruited to each group. There were no statistically significant between-group differences in 30-day survival (15% vs 17%, p = 0.36 (primary outcome measure)) or rates of hospital admission (54% vs 55%, p = 0.67), return of spontaneous circulation (55% vs 55%, p = 0.96), 24-hour survival (31% vs 33%, p = 0.39) or survival to hospital discharge (15% vs 18%, p = 0.33). Although there were no differences in neurological outcome (p = 0.69), the authors reported that there were more intracranial haemorrhages in the tenecteplase group. As recruitment to this study was terminated early, there is a small possibility of a type II error (failing to detect a difference not accounted for by chance alone). However, even if this is the case, the number of patients that would need treatment with thrombolysis before one additional cardiac arrest victim survived would be so high as to make this intervention unfeasible. Thrombolysis has been used by a small number of clinicians on an ad hoc basis to treat of …