319 Bangladesh Journal of Medical Science Vol. 19 No. 02 April’20 Case report: Rescue-Thrombolysis in Cardiac Arrest: The ‘Provider’ of Last Resort. Lim Khai Yen 1 , Shahira Ismail 2 , Shukri Saad 3 , Mohd Hashairi Fauzi 4 , Nik Hisamuddin Nik Ab Rahman 5 Abstract: Cardiac arrest is the leading cause of death globally, and heart disease is known to be a major risk factor for cardiac arrest. In practice, an arrest is presumed to be of cardiac origin unless it is known or likely due to non-cardiac causes. The prognosis of the patient following cardiac arrest is generally poor. Although thrombolytic therapy is well known to be the treatment for myocardial thrombosis, it is not routinely recommended in cardiac arrest due to its potential bleeding adverse efect. We described a case report of successful thrombolytic therapy in cardiac arrest patient Keywords: cardiac arrest; thrombolytic therapy; emergency department Correspondence to: Mohd Hashairi Fauzi, Department of Emergency Medicine, School of Medical Sci- ences, Universiti Sains Malaysia - Health Campus, 16150 Kota Bahru, KubangKerian, Kelantan, MY 16150, Email: hashairi@usm.my 1. Lim Khai Yen 2. Shahira Ismail 3. ShukriSaad 4. MohdHashairiFauzi, Email: hashairi@usm.my 5. Nik Hisamuddin Nik Ab Rahman MD,MMED Department of Emergency Medicine, School of Medical Science, Universiti Sains Malaysia Health Campus, 16150 KubangKerian, Kelantan, Malaysia Bangladesh Journal of Medical Science Vol. 19 No. 02 April’20. Page : 319-321 DOI: https://doi.org/10.3329/bjms.v19i2.45015 Case A 42-year-old lady visited to the Emergency Department (ED) complaint of left-sided chest pain with radiation to jaw, shortness of breath, nausea and vomiting. Her initial vital signs were normal. Physical examination was unremarkable. Her electrocardiogram (ECG) showed ST segment elevation at the inferior leads without right ventricle involvement (fgure 1); and she was treated for inferior ST-elevation myocardial infarction. While preparing for thrombolytic therapy, patient developed ventricular fbrillation (VF). Cardiopulmonary resuscitation (CPR) was commenced and resuscitation was carried out according to Advanced Cardiac Life Support guidelines. Despite efective chest compression and active resuscitation for thirty minutes, there was no sign of return of spontaneous circulation (ROSC). Intravenous thrombolytic agent was then administered over an hour while CPR was ongoing. ROSC achieved at thirty minutes after thrombolytic therapy (fgure 2). Subsequent ECGs showed gradual resolution of ST elevation myocardial infarction (STEMI) (fgure3 & 4). The patient was admitted to Coronary Care Unit (CCU) for a week and was discharge well with good neurological function. Figure 1. ST segment elevation at the inferior leads without right ventricle involvement.