December 2019 - Nina Buchtele

Dr. Nina Buchtele

MedUni Wien RESEARCHER OF THE MONTH December 2019

Increased fibrinolysis as a specific marker of poor outcome after cardiac arrest

Recent data suggest that early increased fibrinolysis may be associated with unfavorable prognosis in cardiac arrest. The current study aimed to assess whether there is an optimal fibrinolysis cut-off value as determined by thrombelastometry at hospital admission to predict poor outcome in a cohort of adult patients with out-of-hospital cardiac arrest.  Patients with out-of-hospital cardiac arrest of presumed cardiac origin, subjected to targeted temperature management, who had achieved return of spontaneous circulation at admission were analysed.
Fibrinolysis was assessed by thrombelastometry at the bedside immediately after hospital admission and is given as maximum lysis (%). The outcome measure was the optimal cut-off for maximum lysis at hospital admission to predict poor outcome (a composite of cerebral performance category 3-5 or death) at day 30, assessed by receiver-operating characteristic curve analysis.  Seventy-eight patients (61% male, median 59 years) were included in the study from March 2014 to March 2017. The maximum lysis cut-off on admission predicting poor 30-day outcome with 100% specificity (95%CI 90-100%) was ≥20%.

Selected Literature

1. Increased Fibrinolysis as a Specific Marker of Poor Outcome After Cardiac Arrest. Buchtele N, Schoergenhofer C, Spiel AO, Jilma B, Schwameis M. Crit Care Med 2018 Aug; doi: 10.1097/CCM.0000000000003352. [Epub ahead of print] PMID: 30096099
2. Asphyxia by Drowning Induces Massive Bleeding Due To Hyperfibrinolytic Disseminated Intravascular Coagulation. Schwameis M, Schober A, Schörgenhofer C, Sperr WR, Schöchl H, Janata-Schwatczek K, Kürkciyan EI, Sterz F, Jilma B. Crit Care Med. 2015 Nov;43(11):2394-402. doi: 10.1097/CCM.0000000000001273. PMID: 26327200
3. Prognosis of overt disseminated intravascular coagulation in patients admitted to a medical emergency department. Schwameis M, Buchtele N, Schober A, Schoergenhofer C, Quehenberger P, Jilma B. Eur J Emerg Med. 2017 Oct;24(5):340-346. doi: 10.1097/MEJ.0000000000000361. PMID: 26703757
4. Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest. Buchtele N, Schober A, Schoergenhofer C, Spiel AO, Mauracher L, Weiser C, Sterz F, Jilma B, Schwameis M. Eur J Intern Med. 2018 Jun 26. pii: S0953-6205(18)30266-8. doi: 10.1016/j.ejim.2018.06.016. [Epub ahead of print]
5. Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence. Buchtele N, Schwameis M, Gilbert JC, Schörgenhofer C, Jilma B. Thromb Haemost. 2018 Jun;118(6):959-978. doi: 10.1055/s-0038-1648251. Epub 2018 May 30.