Alshaya Omar A, Alshaya Abdulrahman I, Badreldin Hisham A, Albalawi Sarah T, Alghonaim Sarah T, Al Yami Majed S
Department of Pharmacy Practice College of Pharmacy King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia.
Pharmaceutical Care Services King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.
Res Pract Thromb Haemost. 2022 Jun 17;6(4):e12745. doi: 10.1002/rth2.12745. eCollection 2022 May.
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.
Evaluate the safety and efficacy of systemic thrombolysis in patients with cardiac arrest due to presumed or confirmed pulmonary embolism or cardiac etiology.
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.
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).
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.
全球每年都会遇到许多心脏骤停病例，生存率较低。在心肺复苏期间使用全身溶栓治疗心脏骤停仍存在争议。
评估全身溶栓治疗疑似或确诊为肺栓塞或心脏病因导致的心脏骤停患者的安全性和有效性。
我们检索了从数据库建立至2021年4月的PubMed和Cochrane数据库，以识别相关的随机对照试验和观察性研究。主要疗效和安全结局分别为出院生存率和报告的出血情况。根据研究设计和心脏骤停的病因进行敏感性分析。
纳入了11项研究，共4696例患者（1178例接受全身溶栓治疗，3518例接受传统治疗）。接受全身溶栓治疗的患者出院生存率高于未接受全身溶栓治疗的患者（风险比[RR]，1.35；95%置信区间[CI]，0.95-1.91）。在24小时（RR，1.24；95%CI，0.97-1.59）和入院时（RR，1.53；95%CI，1.04-2.24）的生存率以及自主循环恢复（ROSC）率（RR，1.34；95%CI，1.05-1.71）方面，使用全身溶栓治疗也更高。对出院生存率和24小时生存率的影响无统计学意义。与未接受全身溶栓治疗相比，接受全身溶栓治疗的患者出血事件增加了65%（RR，1.65；95%CI，1.20-2.27）。
心脏骤停时的全身溶栓治疗并未提高出院生存率，且导致更多出血事件。然而，它提高了入院率和ROSC成功率。
