Clinical Reviews in Emergency Medicine| Volume 57, ISSUE 4, P478-487, October 2019

Can Systemic Thrombolysis Improve Prognosis of Cardiac Arrest Patients During Cardiopulmonary Resuscitation? A Systematic Review and Meta-Analysis

  • Yiwei Wang
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
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  • Maoyun Wang
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
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  • Yuenan Ni
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
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  • Binmiao Liang
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
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  • Zongan Liang
    Reprint Address: Zongan Liang, md, Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
    Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
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      Cardiac arrests are caused in most cases by thromboembolic diseases, such as acute myocardial infarction (AMI) and pulmonary embolism (PE).


      We aimed to ascertain the associations of thrombolytic therapy with potential benefits among cardiac arrest patients during cardiopulmonary resuscitation (CPR).


      We searched PubMed, Embase, and Cochrane databases for studies that evaluated systemic thrombolysis in cardiac arrest patients. The primary outcome was survival to hospital discharge, and secondary outcomes included return of spontaneous circulation (ROSC), 24-h survival rate, hospital admission rate, and bleeding complications.


      Nine studies with a total of 4384 cardiac arrest patients were pooled in the meta-analysis, including 1084 patients receiving systemic thrombolysis and 3300 patients receiving traditional treatments. Compared with conventional therapies, the use of systemic thrombolysis did not significantly improve survival to hospital discharge (13.5% vs. 10.8%; risk ratio [RR] 1.13; 95% confidence interval [CI] 0.92–1.39; p = 0.24, I2 = 35%), ROSC (50.9% vs. 44.3%; RR 1.29; 95% CI 1.00–1.66; p = 0.05, I2 = 73%), and 24-h survival (28.1% vs. 25.6%; RR 1.25; 95% CI 0.88–1.77; p = 0.22, I2 = 63%). We observed higher hospital admission rates for patients receiving systemic thrombolysis (43.4% vs. 30.6%; RR 1.53; 95% CI 1.04–2.24; p = 0.03, I2 = 87%). In addition, higher risk of bleeding was observed in the thrombolysis group (8.8% vs. 5.0%; RR 1.65; 95% CI 1.16–2.35; p = 0.005, I2 = 7%).


      Systemic thrombolysis during CPR did not improve hospital discharge rate, ROSC, and 24-h survival for cardiac arrest patients. Patients receiving thrombolytic therapy have a higher risk of bleeding. More high-quality studies are needed to confirm our results.


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