Abstract
Background
Cardiac arrests are caused in most cases by thromboembolic diseases, such as acute
myocardial infarction (AMI) and pulmonary embolism (PE).
Objective
We aimed to ascertain the associations of thrombolytic therapy with potential benefits
among cardiac arrest patients during cardiopulmonary resuscitation (CPR).
Methods
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.
Results
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%).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: October 05, 2019
Accepted:
July 11,
2019
Received in revised form:
June 15,
2019
Received:
March 27,
2019
Footnotes
Yiwei Wang and Maoyun Wang contributed equally to this work.
Funded by the National Key Research and Development Program of China, China (2016YFC1304303).
Each clinical trial included was approved by the corresponding institution's ethical committee.
Written informed consent was provided by participants of each study.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
