Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2017; 9(12): 830-837
Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.830
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
ARTICLE HIGHLIGHTS
Research background

Patients with out-of-hospital cardiac arrest (OHCA) frequently have post-anoxic encephalopathy, even after successful initial resuscitation. This brain insult can be either transient or definitive, and is the major cause of mortality. Even after successful resuscitation and restoration of cerebral perfusion, brain injury continues to progress due to reperfusion injury.

Research motivation

In the setting of OHCA, there is whole body ischemia and clinical studies have shown conflicting results with 2 studies demonstrating mortality benefit with early Erythropoietin (Epo) administration and a recent randomized controlled trial with no significant benefit. In view of these studies, the authors aim to perform a meta-analysis to assess for any significant mortality benefit of early Epo administration in patients with OHCA.

Research objectives

The primary efficacy outcome in this study was “brain death or Cerebral Performance Category (CPC) score of 5”. Secondary outcomes assessed in this study were “CPC scores 1 and 2-4”, “overall thrombotic events” and “acute coronary stent thrombosis”.

Research 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. The included trials were evaluated for publication bias and data summarized across treatment arms using the random effects model as odds ratio (OR).

Research results

No significant differences were observed between the two groups in brain death or CPC score of 5 (OR = 0.77; 95%CI: 0.42-1.39; I2 = 43%), CPC score 1 (OR = 1.16, 95%CI: 0.82-1.64; I2 = 22%), and CPC score 2-4 (OR = 0.77, 95%CI: 0.44-1.36; I2 = 0%). Epo therapy was associated with a significant increase in overall thrombotic events (OR = 2.41, 95%CI: 1.26-4.62; I2 = 0%) and acute coronary stent thrombosis (OR = 8.16, 95%CI: 1.39-47.99; I2 = 0%).

Research conclusions

This 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.

Research perspectives

Epo administration in patients with OHCA demonstrated an increase in adverse events with no mortality benefit in addition to current standard of care. Based on the currently available literature and this systematic review, further studies are needed in order to assess the safety and efficacy of Epo in Out-Of-Cardiac-Arrest patients.