Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis.

Autor: Heuts S; Department of Cardiothoracic Surgery, Maastricht University Medical Center, MUMC+), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands. sam.heuts@mumc.nl.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands. sam.heuts@mumc.nl., Ubben JFH; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Kawczynski MJ; Department of Cardiothoracic Surgery, Maastricht University Medical Center, MUMC+), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands., Gabrio A; Department of Methodology and Statistics, University Maastricht, Maastricht, The Netherlands.; Care and Public Health Research Institute (CAPHRI), University Maastricht, Maastricht, The Netherlands., Suverein MM; Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Delnoij TSR; Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Kavalkova P; 2nd Department of Medicine-Department of Cardiovascular Medicine, First Medical School, General University Hospital and Charles University in Prague, Prague, Czech Republic., Rob D; 2nd Department of Medicine-Department of Cardiovascular Medicine, First Medical School, General University Hospital and Charles University in Prague, Prague, Czech Republic., Komárek A; Department of Probability and Mathematical Statistics, Faculty of Mathematics and Statistics, Charles University in Prague, Prague, Czech Republic., van der Horst ICC; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands.; Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Maessen JG; Department of Cardiothoracic Surgery, Maastricht University Medical Center, MUMC+), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands., Yannopoulos D; Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA., Bělohlávek J; 2nd Department of Medicine-Department of Cardiovascular Medicine, First Medical School, General University Hospital and Charles University in Prague, Prague, Czech Republic., Lorusso R; Department of Cardiothoracic Surgery, Maastricht University Medical Center, MUMC+), P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands., van de Poll MCG; Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.; School of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Jul 03; Vol. 28 (1), pp. 217. Date of Electronic Publication: 2024 Jul 03.
DOI: 10.1186/s13054-024-05008-9
Abstrakt: Background: The outcomes of several randomized trials on extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out-of-hospital cardiac arrest were examined using frequentist methods, resulting in a dichotomous interpretation of results based on p-values rather than in the probability of clinically relevant treatment effects. To determine such a probability of a clinically relevant ECPR-based treatment effect on neurological outcomes, the authors of these trials performed a Bayesian meta-analysis of the totality of randomized ECPR evidence.
Methods: A systematic search was applied to three electronic databases. Randomized trials that compared ECPR-based treatment with conventional CPR for refractory out-of-hospital cardiac arrest were included. The study was preregistered in INPLASY (INPLASY2023120060). The primary Bayesian hierarchical meta-analysis estimated the difference in 6-month neurologically favorable survival in patients with all rhythms, and a secondary analysis assessed this difference in patients with shockable rhythms (Bayesian hierarchical random-effects model). Primary Bayesian analyses were performed under vague priors. Outcomes were formulated as estimated median relative risks, mean absolute risk differences, and numbers needed to treat with corresponding 95% credible intervals (CrIs). The posterior probabilities of various clinically relevant absolute risk difference thresholds were estimated.
Results: Three randomized trials were included in the analysis (ECPR, n = 209 patients; conventional CPR, n = 211 patients). The estimated median relative risk of ECPR for 6-month neurologically favorable survival was 1.47 (95%CrI 0.73-3.32) with a mean absolute risk difference of 8.7% (- 5.0; 42.7%) in patients with all rhythms, and the median relative risk was 1.54 (95%CrI 0.79-3.71) with a mean absolute risk difference of 10.8% (95%CrI - 4.2; 73.9%) in patients with shockable rhythms. The posterior probabilities of an absolute risk difference > 0% and > 5% were 91.0% and 71.1% in patients with all rhythms and 92.4% and 75.8% in patients with shockable rhythms, respectively.
Conclusion: The current Bayesian meta-analysis found a 71.1% and 75.8% posterior probability of a clinically relevant ECPR-based treatment effect on 6-month neurologically favorable survival in patients with all rhythms and shockable rhythms. These results must be interpreted within the context of the reported credible intervals and varying designs of the randomized trials.
Registration: INPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060 ).
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: