Introduction There are currently around 300,000 cardiac arrests CA) per year in the USA, Cardiopulmonary resuscitation CPR) is an efficacious measure to restore haemody- namic stability in 40±60% of CA cases, with a hospital survival rate of around 15%. Coronary artery disease is the cause of sudden cardiac death in 80% of non-survi- vors. At necropsy, 40±70% of sudden cardiac death vic- tims show evidence of previous myocardial infarction M.Ruiz-BailØn E.AguayodeHoyos M.C.Serrano-Córcoles M.A.Díaz-Castellanos J.A.Ramos-Cuadra A.Reina-Toral Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation Received: 20 July 2000 Final revision received: 23 January 2001 Accepted: 8 March 2001 Published online: 24 April 2001  Springer-Verlag 2001 The named authors stand for the members of the ARIAM Analysis of Delay in Acute Myocardial Infarction) Group; the investi- gators and institutions participating in the ARIAM Group are listed in the appendix M.Ruiz-BailØn  ) ) ´ M.C.Serrano- Córcoles ´ M.A. Díaz-Castellanos ´ J.A.Ramos-Cuadra Intensive Care Unit, Critical Care and Emergencies Department, Hospital de Poniente, 04700 El Ejido, Almería, Spain E-mail: MRB1604@teleline.es Phone: +34-639-629418 Fax: +34-950-570702 E.Aguayo de Hoyos ´ A.Reina-Toral Intensive Care Unit, Critical Care and Emergencies Department, Hospital Universitario Virgen de las Nieves, Granada, Spain Abstract Objective: To evaluate the efficacy and safety of systemic thrombolysis administered to resus- citated patients after cardiac arrest CA) due to an acute myocardial in- farction AMI), through a study of their mortality and haemorrhagic complications. Design: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the da- tabase of the Spanish multi-centre project ªAnalysis of Delay in AMIº ARIAM). Setting: Intensive care ICU) and coronary care CCU) units of 77 Spanish hospitals. Patients and participants: The study period was from 1 January 1995 to 1 January 2000, when 22,922 pati- ents were included in the ARIAM database register; 13,704 were diag- nosed with AMI and we studied 303 of these AMI patients admitted af- ter resuscitation for CA. Measurements and results: Of the 303 patients studied, 228 were male 75.25%); the mean age was 64.57  12.48 years. Systemic thrombolysis was administered to 67 patients group I) and the re- maining 236 patients were managed without this treatment group II). The ICU/CCU mortality rate of the series was 39.93% 121 patients); that of group I was 17.91% 12 pa- tients) and that of group II 46.18% 109 patients) P < 0.00001). Group I required less mechanical ventila- tion group I, 42.85% vs group II, 80.76%; P < 0.00001) and fewer cardiopulmonary resuscitation at- tempts 33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock 14.28% vs 39.01%, P < 0.0001) and anoxic encephalop- athy 8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Lo- gistic regression analysis showed the administration of thrombolysis to be an independent variable that pro- tected against mortality. Conclusions: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemor- rhagic complications. Keywords Acute myocardial infarction ´ Cardiac arrest ´ Cardiopulmonary resuscitation ´ Mortality ´ Complications ´ Thrombolysis Intensive Care Med 2001) 27: 1050±1057 DOI 10.1007/s001340100948 ORIGINAL