Key result
Erythropoietin therapy in out-of-hospital cardiac arrest patients did not improve brain death or CPC score 5 (OR 0.77; 95% CI 0.42-1.39) but increased thrombotic complications.
Why the study?
Does early erythropoietin administration reduce brain death or improve neurological outcomes in adult patients with out-of-hospital cardiac arrest?
Meta-Analysis
Does early erythropoietin administration reduce brain death or improve neurological outcomes in adult patients with out-of-hospital cardiac arrest?
Odds Ratio: 0.77 (95% CI 0.42–1.39)
Early erythropoietin administration after out-of-hospital cardiac arrest does not improve neurological outcomes and significantly increases the risk of thrombotic complications, including acute coronary stent thrombosis.
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: = 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.
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Chaudhary et al. (2017) conducted a meta-analysis in out-of-hospital cardiac arrest (OHCA). Erythropoietin (Epo) vs. standard of care alone was evaluated on brain death or Cerebral Performance Category (CPC) score of 5 (OR 0.77, 95% CI 0.42-1.39). Erythropoietin therapy in out-of-hospital cardiac arrest patients did not improve brain death or CPC score 5 (OR 0.77; 95% CI 0.42-1.39) but increased thrombotic complications.
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