Frequency of Complications of Cardiopulmonary Resuscitation After Thrombolysis During Acute Myocardial Infarction Karl H. Scholz, MD, Ulrich Tebbe, MD, Christoph Herrmann, MD, Jaroslav Wojcik, MD, Renate Lingen, MD, Joerg M. Chemnitius, MD, Stephan Brune, MD, and Heinrich Kreuzer, MD Proionged external cardiac massage is often regarded as a contraindication for thromboiytic therapy because of the risk of fatal hemorrhage. The influence of cardiopulmonary resuscitation on complications of thromboiytic bleeding was assessed analyzing data of ail patients with myocardial infarction admitted to our clinic during the lo-year period between 1978 and 1987. From the total of 2,147 patients with acute myocardiai infarction, 590 received thromboiytic therapy (intracoronary in 229, intravenous in 400). Of these, 43 patients underwent prolonged cardiopuimonary resuscitation and received thromboiysis within a time interval of O.l mV in standard leads and >0.2 mV in precordial leads), increase of creatine kinase activity to at least threefold of normal (>200 U/liter) with a ratio of creatine kinase-MB fraction of 16%, or alternatively by autopsy findings. Thromboiytii therapy: All patients with acute myocardial infarction received intravenous therapy with heparin (bolus of 5,000 U followed by a doseof 800 to 1,200 U/hour) and nitrates. Since 1979, a total of 590 patients (duration of symptoms 7 Second infarction Hospital stay of survivors (days) *Percentages calculated CPR = cardiopulmonary

No CPR

p Value

43 58.3129-79 33 (77%)

547 58.6127-89 444 (81%)

7 (16%) 25 (58%) 11 (26%)

57 (10%) 429 (78%) 61 (11%)

0.16

129 (24%)

0.64

10 (23%) 21 (49%)

355 (65%) 63 (11%) 84 (15%)

12 (28%) 13 (30%) 22 (51%)

19 (44%) 2 (4.7%) 35 (81%) 33 6 10 20

0.89 0.48

(77%)

271 (49.5%) 274 (50%) 2 (0.5%)

0.62

379 (69%)

0.13

378 (69%)

0.38 0.72

(14%)

95 (17%)

(23%) (46%)

12 (2%) 34 (6%)

13 (65%*) 3 (15%*) 4 (20%*) 3 (7%) 30.4 + 13.3