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F Spöhr

Publications and source records attributed to F Spöhr.

8 recordsLinked to original sources
PubMed2005

[Errors and risks in perioperative thrombolysis therapy].

Until recently, perioperative thrombolysis has always been thought to be a contraindication, because of the risk of bleeding complications. However, many case reports now show that thrombolytic drugs can be successfully used in the perioperative period. Possible indications for perioperative thrombolysis are massive pulmonary embolism and cardiopulmonary resuscitation which are also important causes of cardiac arrest. Thrombolysis can be the decisive therapeutical option, e.g. when normal cardiopulmonary resuscitation measures are not successful. Nevertheless, even against the background of many positive case reports the indication for perioperative thrombolysis should be a case-specific decision as the frequency of complications depends on the surgical intervention and must be weighed against the possible benefits of early thrombolysis. For perioperative thrombolysis there are no data available showing a beneficial effect of one particular therapeutic regimen. In the literature it is suggested that thrombolysis should be performed as quickly as possible, because the risk of bleeding complications depends more on the duration of thrombolysis than on the dosage or the thrombolytic drug itself.

Cardiopulmonary Resuscitation↗
PubMed2005

International multicentre trial protocol to assess the efficacy and safety of tenecteplase during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest: the Thrombolysis in Cardiac Arrest (TROICA) Study.

Prehospital cardiac arrest has been associated with a very poor prognosis. Acute myocardial infarction and massive pulmonary embolism are the underlying causes of out-of-hospital cardiac arrest in 50-70% of patients. Although fibrinolysis is an effective treatment strategy for both myocardial infarction and pulmonary embolism, clinical experience for this therapy performed during resuscitation has been limited owing to the anticipated risk of severe bleeding complications. The TROICA study is planned as one of the largest randomized, double-blind, placebo-controlled trials to assess the efficacy and safety of prehospital thrombolytic therapy in cardiac arrest of presumed cardiac origin. Approximately 1000 patients with cardiac arrest will be randomized at approximately 60 international study centres to receive either a weight-adjusted dose of tenecteplase or placebo after the first dose of a vasopressor. Patients can be included if they are at least 18 years, presenting with a witnessed cardiac arrest of presumed cardiac origin, and if either basic life support had started within 10 min of onset and had been performed up to 10 min or advanced life support is started within 10 min of onset of cardiac arrest. Primary endpoint of the study is the 30-day survival rate, and the coprimary endpoint is hospital admission. Secondary endpoints are the return of spontaneous circulation (ROSC), survival after 24 h, survival to hospital discharge, and neurological performance. Safety endpoints include major bleeding complications and symptomatic intracranial haemorrhage.

Adolescent↗
PubMed2005

[Prehospital thrombolysis during cardiopulmonary resuscitation].

Although prehospital cardiac arrest has an incidence of 40-90/100,000 inhabitants per year, there has been a lack of therapeutic options to improve the outcome of these patients. Of all cardiac arrests, 50-70% are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis has been shown to be a causal and effective therapy in patients with AMI or PE who do not suffer cardiac arrest. In contrast, experience with the use of thrombolysis during cardiac arrest has been limited. Thrombolysis during cardiopulmonary resuscitation (CPR) acts directly on thrombi or emboli causing AMI or PE. In addition, experimental studies suggest that thrombolysis causes an improvement in microcirculatory reperfusion after cardiac arrest. In-hospital and prehospital case series and clinical studies suggest that thrombolysis during CPR may cause a restoration of spontaneous circulation and survival even in patients that have been resuscitated conventionally without success. In addition, there is evidence for an improved neurological outcome in patients receiving a thrombolytic therapy during during CPR. A large randomized, double-blind multicenter trial that has started recently is expected to show if this new therapeutic option can generally improve the prognosis of patients with cardiac arrest.

Cardiopulmonary Resuscitation↗
PubMed2005

Thrombolytics in CPR. Current advantages in cardiopulmonary resuscitation.

Cardiac arrest carries a very poor prognosis. More than 70% of cardiac arrests are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis during CPR has two major effects: first, it causally treats the condition that caused cardiac arrest and second, it has been shown to have beneficial effects on the microcirculatory cerebral reperfusion after cardiac arrest. However, this treatment has been widely withheld mainly because of the fear of severe bleeding complications. We reviewed the currently available in- and out-of-hospital studies on thrombolysis during CPR. Most studies found that thrombolytic therapy during CPR improves the chance for a restoration of spontaneous circulation in patients suffering from cardiac arrest and may even result in a better outcome. In addition, the neurological condition of surviving patients may be markedly improved by thrombolysis. Although thrombolytic therapy is associated with a risk of bleeding complications, currently available data do not suggest an increase of bleeding complications if thrombolysis is administered during CPR. Recently, a large randomized multicentre study has started to assess the efficacy and safety of thrombolysis during prehospital CPR.

Cardiopulmonary Resuscitation↗
PubMed2003

Thrombolytic therapy during or after cardiopulmonary resuscitation. Efficacy and safety of a new therapeutic approach.

Acute myocardial infarction (MI) and massive pulmonary embolism (PE) are the underlying causes of cardiac arrest in more than 70% of patients. Thrombolysis is an effective therapy for patients presenting with acute MI or massive PE and has experimentally shown to have beneficial effects on the microcirculatory reperfusion after cardiac arrest, but this treatment has been widely withheld up to now mainly because of the fear of severe bleeding complications. To assess the efficacy and safety of thrombolysis after and during cardiopulmonary resuscitation (CPR), we reviewed the currently available clinical studies on thrombolysis after and during CPR. From these data, there is increasing evidence that thrombolytic therapy during or shortly after CPR can contribute significantly to a restoration of spontaneous circulation in patients suffering from cardiac arrest. Although the use of thrombolytic agents is associated with a higher incidence of bleeding complications, currently available data do not suggest an increase of complications if thrombolysis is combined with CPR. Considering the poor outcome of patients suffering from cardiac arrest and the lack of effective and causal treatment options, the potential risks of thrombolysis after or during CPR probably do not outweigh the benefits of this treatment option.

Cardiopulmonary Resuscitation↗
PubMed1997

Role of renal nerves and endogenous dopamine in amino acid-induced glomerular hyperfiltration.

The present study was performed to clarify whether urinary dopamine excretion (UDAV) and renal nerves are involved in the increase in glomerular filtration rate (GFR) induced by amino acid (AA) infusion. In thiopental-anesthetized rats, L-phenylalanine-free solutions of 10 AA (10%) either with (AATyr, n = 10) or without (AA0, n = 10) L-tyrosine (0.5%) were infused. Compared with baseline values, AATyr increased GFR from 0.83 +/- 0.05 to 1.00 +/- 0.04 ml.min-1.100 g-1 (P < 0.01) and UDAV almost fivefold from 5.81 +/- 0.46 to 28.1 +/- 7.4 pmol.min-1.100 g-1 (P < 0.01). In contrast, infusion of AAo increased GFR as did AATyr but did not significantly change UDAV. The DA2-receptor antagonist S(-)-sulpiride dose-dependently (0.5 to 15 micrograms.min-1.100 g-1) inhibited the GFR response to AA infusion but did not affect UDAV. In rats that had undergone chronic bilateral renal denervation (DNX), the AA-induced hyperfiltration was abolished completely, regardless of whether L-tyrosine was present. DNX did not affect basal UDAV, but the increase in UDAV in response to AATyr was attenuated compared with rats with innervated kidneys. Renal sodium excretion was increased almost twofold due to AA infusion and did not correlate with UDAV significantly. The data suggest 1) that urinary dopamine does not play a significant role in the regulation of kidney function, 2) that renal innervation is essential in the GFR response to systemic AA infusion, and 3) that a dopaminergic mechanism apart from tubular dopamine excretion is involved as well.

Amino Acids↗