Use of systemic thrombolytic therapy in patients with non-traumatic cardiac arrest: A systematic review and meta-analysis
Objective: To better delineate the benefits and risks of systemic thrombolytic therapy in
patients with cardiac arrest from non-traumatic etiologies.
Data sources: MEDLINE, EMBASE, and SCOPUS were systematically searched up to
November of 2017.
Study Selection: All retrospective and prospective studies in which systemic thrombolytic
therapy was used during the sequence of cardiopulmonary resuscitation (CPR) or shortly after
achieving return of spontaneous circulation (ROSC) were included.
Data extraction: The following variable results were extracted from intervention and control
groups if available: rate of ROSC, survival after 24 hours, survival at discharge, neurological
performance at 6 months based on a favorable Cerebral Performance Categories Scale (1 or 2)
and major bleeding events.
Data Synthesis: Eight retrospective studies and 6 prospective studies were included in the
qualitative analysis. Research synthesis was conducted when at least 4 studies were available
for an outcome, which limited the analysis of major bleeding events and neurologic outcomes.
Benefit of thrombolytic therapy in survival to discharge showed a moderate beneficial effect
(OR = 2.79, 2.11–3.69) in the retrospective study analysis while in the prospective study analysis
no statistically significant benefit was found (OR = 1.27, 0.77–2.10). Benefit of thrombolysis in
the rate of ROSC was not statistically significant in the prospective analysis (OR = 1.59, 0.92–
2.76, p = 0.138) as well as survival at 24 hours (OR = 1.17, 0.72–1.71).
Conclusions: The widespread use of thrombolytics in patients with non-traumatic cardiac
arrest does not seem to improve major outcomes, including survival to discharge. However,
the modest benefit found in the retrospective study analysis suggests a subgroup of patients
that may benefit from this therapy.
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