Clot-busting Drug Seems to Work a Small Miracle

Cardiac arrest is nearly always fatal. It happens when the electrical signal regulating the heartbeat is disrupted by a heart attack, severe coronary heart disease, a pulmonary embolus (blood clot in the lungs), electric shock, or some other cause. The brain usually suffers permanent damage within 4 to 6 minutes.

The standard treatment for cardiac arrest (as you know from “ER” or “Gray’s Anatomy”) includes CPR (cardiopulmonary resuscitation), drugs like epinephrine (adrenaline), and defibrillation – an electric shock to the heart. But in spite of these measures, relatively few of the victims make it out of hospital alive.

A new fibrinolytic drug (or ‘clot-buster’) called tenecteplase is approved by the FDA for use to help dissolve blood clots in acute heart attacks or pulmonary embolism. Now ER doctors have given it to patients with cardiac arrest who didn’t respond to standard measures. (Clot busters aren’t typically used in cardiac arrest – it’s been thought that they might increase bleeding with CPR.) The number of patients who were revived (return of spontaneous circulation) was double that in those who didn’t get the clot buster, and some of them completely recovered normal brain function and left hospital.

This may not seem a giant breakthrough, but it does represent a small but important step forward. Further studies will show just where this approach fits into the standard procedure for handling cardiac arrest.