Role of Streptokinase in Cardiac Arrest due to Suspected Acute Coronary Syndrome: A Case of Successful Resuscitation

Background: Streptokinase, introduced in the 1950s, is a well-established thrombolytic agent commonly used for the management of acute myocardial infarction (AMI) due to its ability to break down fibrin clots.It remains a widely used fibrinolytic agent in resource-limited settings due to its affordability and accessibility.Its role during ongoing cardiopulmonary resuscitation (CPR) in cardiac arrest caused by suspected acute coronary syndrome (ACS) remains uncertain.Case report: A 50-year-old male presented to the emergency department (ED) in cardiac arrest following a sudden collapse.The initial rhythm was ventricular fibrillation (VF).Despite multiple cycles of advanced cardiac life support (ACLS), including defibrillation, adrenaline, and amiodarone, return of spontaneous circulation (ROSC) was not achieved.Given the strong suspicion of ACS, streptokinase (1.5 million units IV bolus) was administered during the 8th cycle of CPR.After 18 cycles of CPR and 15 defibrillation shocks, ROSC was achieved.Post-resuscitation ECG showed anteroseptal ST-elevation myocardial infarction (STEMI).Echocardiography revealed anterior wall hypokinesis and a left ventricular ejection fraction of 35%.The patient received dual antiplatelet therapy, statins, inotropes, and targeted temperature management.He was later weaned from ventilation and discharged with a Glasgow Coma Scale (GCS) score of E2 VT M5, indicating good neurological recovery.Conclusion: This case highlights the potential role of streptokinase as a cost-effective thrombolytic during CPR in suspected ACS, particularly in resource-limited settings where percutaneous coronary intervention or newer fibrinolytics are unavailable.Thrombolysis during CPR may improve outcomes in carefully selected patients, though bleeding risk must be considered.Further research is needed to establish clear guidelines for such interventions.