Open AccessThrombolytic therapy in cardiac arrest caused by cardiac etiologies or presumed pulmonary embolism: An updated systematic review and meta‐analysis
Author(s) -
Alshaya Omar A.,
Alshaya Abdulrahman I.,
Badreldin Hisham A.,
Albalawi Sarah T.,
Alghonaim Sarah T.,
Al Yami Majed S.
Publication year - 2022
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12745
Subject(s) - medicine , thrombolysis , return of spontaneous circulation , pulmonary embolism , etiology , relative risk , cardiology , cardiopulmonary resuscitation , hazard ratio , confidence interval , resuscitation , anesthesia , myocardial infarction
Background Many cardiac arrest cases are encountered annually worldwide, with poor survival. The use of systemic thrombolysis during cardiopulmonary resuscitation for the treatment of cardiac arrest remains controversial. Objectives Evaluate the safety and efficacy of systemic thrombolysis in patients with cardiac arrest due to presumed or confirmed pulmonary embolism or cardiac etiology. Methods We searched the PubMed and Cochrane databases from inception through April 2021 to identify relevant randomized controlled trials and observational studies. The primary efficacy and safety outcomes were survival to hospital discharge and reported bleeding, respectively. Sensitivity analysis was performed on the basis of study design and etiology of cardiac arrest. Results Eleven studies were included, with 4696 patients (1178 patients received systemic thrombolysis, and 3518 patients received traditional therapy). There was a higher rate of survival to hospital discharge in patients who received systemic thrombolysis versus no systemic thrombolysis (risk ratio [RR], 1.35; 95% confidence interval [CI], 0.95‐1.91). There were also higher rates of survival at 24 hours (RR, 1.24; 95% CI, 0.97‐1.59) and hospital admission (RR, 1.53; 95% CI, 1.04‐2.24), and return of spontaneous circulation (ROSC) (RR, 1.34; 95% CI, 1.05‐1.71) with the use of systemic thrombolysis. Impacts on survival to discharge and survival at 24 hours were not statistically significant. Patients receiving systemic thrombolysis had a 65% increase in bleeding events compared with no systemic thrombolysis (RR, 1.65; 95% CI, 1.20‐2.27). Conclusion Systemic thrombolysis in cardiac arrest did not improve survival to hospital discharge and led to more bleeding events. However, it increased the rates of hospital admission and ROSC achievement.