The following is a summary of “Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis,” published in the July 2024 issue of Critical Care by Heuts et al.
Past studies on ECPR for cardiac arrest used p-values, limiting the ability to show the actual probability of meaningful patient improvements.
Researchers conducted a retrospective study assessing the probability of ECPR for improving neurological outcomes by Bayesian method in RCTs.
They reviewed RCTs comparing ECPR-based and conventional CPR for refractory out-of-hospital cardiac arrest from 3 databases. The primary outcome for 6-month neurologically favorable survival for all rhythms, was analyzed using Bayesian hierarchical meta-analysis while secondary analysis focused on shockable rhythms. Bayesian methods with vague priors were used to estimate relative risks, absolute risk differences, numbers needed to treat, and posterior probabilities of clinically relevant risk difference thresholds.
The result showed 3 RCTs with ECPR (n = 209 patients) and conventional CPR (n = 211 patients). A significant difference was observed for ECPR in improving neurological outcomes after 6 months in comparison to conventional CPR, ECPR increased the chance of good neurological 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 observing an absolute risk difference exceeding 0% and 5% were 91.0% and 71.1%, respectively, across all cardiac rhythms, and 92.4% and 75.8% in patients with shockable rhythms.
Investigators concluded that bayesian analysis indicates potential benefit of 71.1% and 75.8% probability of a clinically significant ECPR on 6-month neurologically favorable survival, but evidence is uncertain and requires further investigation.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05008-9