Clinical paperA meta-analysis of cardiopulmonary resuscitation with and without the administration of thrombolytic agents☆
Introduction
Cardiopulmonary resuscitation (CPR) is essential for the treatment of cardiac arrest and protection of cerebral function. However, the efficacy of this treatment is still unsatisfactory even after 40 years. The most common causes of cardiac arrest are acute myocardial infarction (AMI) and massive pulmonary embolism (PE). Moreover, CPR also results in microthrombosis. From this we know that it is feasible to perform thrombolysis during CPR. However, the therapy has been in question because of the anticipated severe bleeding risk. Some research groups have studied the efficacy of thrombolysis during CPR. However, there is some inconsistency in the results, which affects evaluation of the efficacy of thrombolytic therapy. Meta-analysis is a method of synthesise a group of data composed of small samples received from different research and to analyse data from each quantitatively to increase the validity of the final conclusion. In order to evaluate the effect of thrombolytic therapy on cardiac arrest patients who had been given CPR, we did a meta-analysis.
Section snippets
Materials
Research papers were searched from the MEDLINE database from 1966 to August 2004.
Literature research method
Keywords used in the search were [(cardiac arrest) or (cardiopulmonary resuscitation) or (cardiopulmonary-cerebral resuscitation)] and [thrombolysis or (thrombolytic agent) or urokinase or streptokinase or (tissue-type plasminogen activator) or t-PA]. The search was limited by the search words of “>19 years”, “Publication Date since 1966/01/01 till 2004/08/01”, “English”, “Human” and “MEDLINE”. We excluded those
Eligibility of literature
The search retrieved 121 papers, and 9 of them2, 3, 4, 5, 6, 7, 8, 9, 10 were cohort studies on cardiopulmonary resuscitation and thrombolysis in the same period. One paper11 was retrieved from MEDLINE after searching the relevant references. However, the authors did not present details of the groups of patients, the types and dose of thrombolytic agents and the criteria for severe bleeding. This paper was finally excluded in this meta-analysis. Another paper8 was also excluded because it
Discussion
Currently, the outcome of cardiopulmonary resuscitation (CPR) is still not satisfactory. The successful resuscitation rate in the hospital setting lies between 15% and 25% and then in out of hospital arena it is less than 5%. Some cases have an enormous neurological deficit. Approximately 81% of cardiac arrests are caused by coronary atherosclerotic heart disease. Immediate coronary artery angiography in those patients who have undergone successful CPR shows that 48% of them had acute coronary
Conclusion
Many researchers consider that it is feasible to perform thrombolytic therapy during or after CPR. The possible advantage of thrombolytic therapy seems to outweigh the potential risks in CPR. Thus, the effect of thrombolysis in reducing morbidity and mortality should not be ignored. The studies of thrombolytic therapy during or after CPR are scattered and retrospective. Therefore, large randomised, prospective multicentre studies should be conducted to examine the indications and decrease the
Conflict of interest
There are no financial and personal relationships with other people or organizations that could influence our work inappropriately.
Acknowledgement
This work was supported by the Great Technology Fund of Guangzhou (2004Z3-E0381).
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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2005.11.016.