[ @entity548 after XXXX with cardiopulmonary resuscitation and thrombolytic therapy].

@entity1 @entity548 @entity26 @entity3459 @entity51 @entity1167 @entity6305 @entity583 @entity1363 @entity99 @entity3575
Adverse effects of resuscitation due to closed-chest cardiac massage are common, and the incidence is increased when an incorrect technique is used. Nevertheless, thrombolytic therapy of a @entity583 can become necessary even after cardiopulmonary resuscitation (CPR). In these @entity1 , the risk of thrombolytic therapy-induced @entity548 is immanent. CASE REPORTS. Within 9 months, two male @entity1 aged 44 and 52 years were admitted to the intensive care unit after out-of-hospital CPR for @entity583 with @entity1167 . In both cases, thrombolytic therapy was undertaken due to the cardiovascular situation or echocardiographic results. Thrombolytic therapy was successful with regard to the ECG changes, but a few hours later both @entity1 demonstrated increasing cardiovascular instability. After abdominal sonography, @entity548 was suspected. Emergency laparotomy became unavoidable, although the coagulation profile was severely impaired in both @entity1 (Tables 1 and 2). Anaesthetic management was characterised by introduction of central venous and intra-arterial catheters, replacement of volume and @entity26 carriers using large-bore IV lines, restoration of coagulation factors with fresh frozen plasma, and the choice of "modified neuroleptanaesthesia" with blood pressure-adjusted, small doses of @entity3575 , @entity1363 , and @entity6305 . Intraoperatively, a @entity99 due to closed-chest cardiac massage was found in both cases. The postoperative courses were complicated by respiratory problems, which led to prolonged mechanical ventilation, but both @entity1 survived without remarkable @entity51 . CONCLUSION. In @entity1 with thrombolytic therapy after CPR and persisting cardio-vascular instability, a resuscitation injury with consequent @entity548 should be suspected. For diagnosis, chest X-ray films and abdominal and thoracic sonography are useful and practicable, even at the bedside. Anaesthetic management should focus on adequate monitoring, replacement of volume and @entity26 carriers, fast restoration of @entity3459 , and careful, blood pressure-adjusted maintenance of anaesthesia.
