Wang Yiwei, Wang Maoyun, Ni Yuenan, Liang Binmiao, Liang Zongan
Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.
J Emerg Med. 2019 Oct;57(4):478-487. doi: 10.1016/j.jemermed.2019.07.011. Epub 2019 Oct 5.
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, I = 35%), ROSC (50.9% vs. 44.3%; RR 1.29; 95% CI 1.00-1.66; p = 0.05, I = 73%), and 24-h survival (28.1% vs. 25.6%; RR 1.25; 95% CI 0.88-1.77; p = 0.22, I = 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, I = 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, I = 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.
大多数情况下，心脏骤停是由血栓栓塞性疾病引起的，如急性心肌梗死（AMI）和肺栓塞（PE）。
我们旨在确定在心肺复苏（CPR）期间，心脏骤停患者接受溶栓治疗与潜在益处之间的关联。
我们检索了PubMed、Embase和Cochrane数据库，以查找评估心脏骤停患者全身溶栓治疗的研究。主要结局是出院生存率，次要结局包括自主循环恢复（ROSC）、24小时生存率、住院率和出血并发症。
共有9项研究纳入了荟萃分析，涉及4384例心脏骤停患者，其中1084例接受全身溶栓治疗，3300例接受传统治疗。与传统治疗相比，全身溶栓治疗并未显著提高出院生存率（13.5%对10.8%；风险比[RR]1.13；95%置信区间[CI]0.92 - 1.39；p = 0.2）、ROSC（50.9%对44.3%；RR 1.29；95% CI 1.00 - 1.66；p = 0.05）和24小时生存率（28.1%对25.6%；RR 1.25；95% CI 0.88 - 1.77；p = 0.22）。我们观察到接受全身溶栓治疗的患者住院率更高（43.4%对30.6%；RR 1.53；95% CI 1.04 - 2.24；p = 0.03）。此外，溶栓组的出血风险更高（8.8%对5.0%；RR 1.65；95% CI 1.16 - 2.35；p = 0.005）。
CPR期间的全身溶栓治疗并未提高心脏骤停患者的出院率、ROSC和24小时生存率。接受溶栓治疗的患者出血风险更高。需要更多高质量研究来证实我们的结果。
