Use of systemic thrombolytic therapy in patients with non-traumatic cardiac arrest: A systematic review and meta-analysis
Daniel Cordoba MD, Eneko Larumbe PhD, Brittany N. Rosales MD, Kenneth Nugent MD
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.
Keywords: Thrombolytic therapy, cardiac arrest, advanced cardiac life support, cardiopulmonary resuscitation, tissue plasminogen activator
Article citation: Cordoba D, Eneko Larumbe E, Rosales BN, Nugent K. Use of systemic thrombolytic therapy in patients with non-traumatic cardiac arrest: a systematic review and meta-analysis. The Southwest Respiratory and Critical Care Chronicles 2019;7(28):7–17
From: Department of Internal Medicine (DC, BNR, KN) and the Clinical Research Institute (EL), Texas Tech University Health Sciences Center, Lubbock, Texas
Reviewer: Scott Shurmur MD
Conflicts of interest: none
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
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