Successful Resuscitation of Cardiac Arrest with Concurrent Intravenous Thrombolysis during Cardiopulmonary Resuscitation.

Abstract

Thrombolytic therapy has long been considered a relative contraindication during cardiopulmonary resuscitation (CPR), mainly due to concerns about fatal bleeding complications. However, in patients with acute myocardial infarction (AMI), untreated coronary thrombosis remains a major cause of unsuccessful resuscitation. We report the case of a 66-year-old man with a history of hypertension and cerebral infarction who presented with chest pain, subsequently developed cardiac arrest, and was successfully resuscitated after concurrent intravenous thrombolysis during CPR. The patient collapsed after 1 h of persistent chest pain. Emergency medical services initiated advanced life support, including chest compressions, airway management, and adrenaline administration. On hospital arrival, the patient experienced recurrent cardiac arrest. Despite prolonged resuscitation attempts, spontaneous circulation could not be sustained. Following family consent, intravenous thrombolytic therapy with heparin and alteplase was administered during ongoing CPR. Following thrombolytic therapy, sustained return of spontaneous circulation was achieved. Coronary angiography confirmed right coronary artery thrombosis, and percutaneous coronary intervention with stent implantation was performed. The patient was stabilized with temporary pacing, transferred to the intensive care unit, and later discharged with full neurological recovery. This case suggests that intravenous thrombolysis administered during CPR for AMI-related cardiac arrest may be a feasible rescue strategy when conventional measures are insufficient. Early thrombolytic decision-making, high-quality CPR, and multidisciplinary collaboration contributed to the favorable outcome. This report adds to the growing body of evidence regarding the potential role of thrombolysis in selected resuscitation scenarios.