Elsevier

Resuscitation

Volume 83, Issue 12, December 2012, Pages 1451-1455
Resuscitation

Clinical Paper
Hyperfibrinolysis in out of hospital cardiac arrest is associated with markers of hypoperfusion

https://doi.org/10.1016/j.resuscitation.2012.05.008Get rights and content
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Abstract

Aim of the study

This study investigated the incidence of hyperfibrinolysis upon emergency department (ED) admission in patients with out of hospital cardiac arrest (OHCA), and the association of the degree of hyperfibrinolysis with markers of hypoperfusion.

Methods

From 30 OHCA patients, cardiopulmonary resuscitation (CPR) time, pH, base excess (BE), and serum lactate were measured upon ED admission. A 20% decrease of rotational thromboelastometry maximum clot firmness (MCF) was defined as hyperfibrinolysis. Lysis parameters included maximum lysis (ML), lysis onset time (LOT) and lysis index at 30 and 45 min (LI30/LI45). The study was approved by the Human Subjects Committee.

Results

Hyperfibrinolysis was present in 53% of patients. Patients with hyperfibrinolysis had longer median CPR times (36 (15–55) vs. 10 (7–18) min; P = 0.001), a prolonged activated partial thromboplastin time (54 ± 16 vs. 38 ± 10 s; P = 0.006) and elevated D-dimers (6.1 ± 2.1 vs. 2.3 ± 2.0 μg/ml; P = 0.02) when compared to patients without hyperfibrinolysis. Hypoperfusion markers, including pH (6.96 ± 0.11 vs. 7.17 ± 0.15; P < 0.001), base excess (−20.01 ± 3.53 vs. −11.91 ± 6.44; P < 0.001) and lactate (13.1 ± 3.7 vs. 8.0 ± 3.7 mmol/l) were more disturbed in patients with hyperfibrinolysis than in non-hyperfibrinolytic subjects, respectively. The LOT showed a good association with CPR time (r = −0.76; P = 0.003) and lactate (r = −0.68; P = 0.01), and was longer in survivors (3222 ± 34 s) than in non-survivors (1356 ± 833; P = 0.044).

Conclusion

A substantial part of OHCA patients develop hyperfibrinolysis in association with markers for hypoperfusion. Our data further suggest that the time to the onset of clot lysis may be an important marker for the severity of hyperfibrinolysis and patient outcome.

Keywords

Cardiopulmonary arrest
Haemostasis
Shock
Fibrinolysis

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.05.008.