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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis
Rahul Chaudhary, Jalaj Garg, Parasuram Krishnamoorthy, Kevin Bliden, Neeraj Shah, Nayan Agarwal, Rahul Gupta, Abhishek Sharma, Karl B Kern, Nainesh C Patel, Paul Gurbel
Rahul Chaudhary, Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
Jalaj Garg, Neeraj Shah, Nainesh C Patel, Division of Cardiology, Lehigh Valley Health Network, Allentown, PA 18103, United States
Parasuram Krishnamoorthy, Department of Medicine, Division of Cardiology, Einstein Healthcare Network, Philadelphia, PA 19141, United States
Kevin Bliden, Paul Gurbel, Inova Heart and Vascular Institute, Inova Medical Center, Fairfax, VA 22042, United States
Nayan Agarwal, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32611, United States
Rahul Gupta, Queens Cardiac Care, Queens, NY 11428, United States
Abhishek Sharma, Division of Cardiovascular Medicine, State University of New York, Brooklyn, NY 12246, United States
Karl B Kern, Division of Cardiology, University of Arizona College of Medicine, Tucson, AZ 85721, United States
Author contributions: All the authors contributed to this manusscript; Chaudhary R and Garg J contributed equally to this work.
Conflict-of-interest statement: All authors report no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jalaj Garg, MD, FESC, Division of Cardiology, Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Allentown, PA 18103, United States. jalaj.garg@lvhn.org
Telephone: +1-585-7660898 Fax: +1-610-4023225
Received: June 15, 2017
Peer-review started: June 19, 2017
First decision: July 17, 2017
Revised: November 6, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 26, 2017
Processing time: 189 Days and 8 Hours
AIM
To assess safety and efficacy of early erythropoietin (Epo) administration in patients with out-of-hospital cardiac arrest (OHCA).
METHODS
A systematic literature search was performed using PubMed, MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science and Cochrane databases, of all studies published from the inception through October 10, 2016. Inclusion criteria included: (1) Adult humans with OHCA and successful sustained return of spontaneous circulation; and (2) studies including mortality/brain death, acute thrombotic events as their end points. Primary efficacy outcome was “brain death or Cerebral Performance Category (CPC) score of 5”. Secondary outcomes were “CPC score 1, and 2-4”, “overall thrombotic events” and “acute coronary stent thrombosis”.
RESULTS
We analyzed a total of 606 participants (n = 276 received Epo and n = 330 with standard of care alone) who experienced OHCA enrolled in 3 clinical trials. No significant difference was observed between the Epo and no Epo group in brain death or CPC score 5 (OR = 0.77; 95%CI: 0.42-1.39), CPC score 1 (OR = 1.16, 95%CI: 0.82-1.64), and CPC score 2-4 (OR = 0.77, 95%CI: 0.44-1.36). Epo group was associated with increased thrombotic complications (OR = 2.41, 95%CI: 1.26-4.62) and acute coronary stent thrombosis (OR = 8.16, 95%CI: 1.39-47.99). No publication bias was observed.
CONCLUSION
Our study demonstrates no improvement in neurological outcomes and increased incidence of thrombotic events and acute coronary stent thrombosis in OHCA patients who were treated with Epo in addition to standard therapy.
Core tip: This manuscript suggested that: (1) No improvement in neurological outcomes with erythropoietin (Epo) administration after out of hospital cardiac arrest; and (2) Epo administration was also associated with increased thrombotic events and acute stent thrombosis.
