Evaluating the risks of thrombolysis during CPR in thromboembolic cardiac arrest

Abstract

This study focuses on identifying the adverse effects of thrombolysis when used during CPR in patients with cardiac arrest. Since CPR guidelines have changed in the past 10 years, which they now suggest that tPA can be administrated in patients with suspected cardiac arrest of an embolic nature, various studies have been carried out to identify the effectiveness of this treatment. This study systematically identifies and critically appraises the literature available about this subject. The PICO framework is Population: Adults with cardiac arrest due to or suspected thromboembolism, Intervention: administration of thrombolysis during CPR, Comparison: No comparison, Outcome: Adverse effects. Does the question presented in this study is “In adults undergoing cardiac arrest due to thromboembolism, does the use of thrombolysis during CPR cause adverse effects?” Since CPR guidelines started recommending the use of thrombolysis during CPR since 2005, all studies from that period onwards were included, except for a few that were handpicked from a manual reference search. The use of HyDI Interface and individual access to 25 related databases was carried to conduct the literature search. To ensure that only articles of quality were selected, only peer-reviewed journals were used. The studies found, which included 2 RCT’s and several cohort studies were appraised using the CASP tool, and during the appraisal process, the reliability and validity of the studies was analysed along with the related outcomes. The adverse effects related to the combination of thrombolysis and CPR was the main outcome that this review focused on, however ROSC was also discussed since this factor affects the importance of knowing the potential adverse effects this combination of treatment might cause. All studies identified a small percentage of bleeding events, and while some were of clinical significance, none were of statistical significance. Overall, incongruent results amongst the studies was identified pertaining ROSC, since the small cohort studies suggested that thrombolysis is effective in achieving ROSC while the large RCT’s showed that this treatment has no effect. Thus, recommendations for further research and ensuring good nursing assessment skills in patients with acute deterioration has been provided.