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

Heuts, S; Ubben, JFH; Kawczynski, MJ; Gabrio, A; Suverein, MM; Delnoij, TSR; Kavalkova, P; Rob, D; Komárek, A; van der Horst, ICC; Maessen, JG; Yannopoulos, D; Bělohlávek, J; Lorusso, R; van de Poll, MCG

doi:10.1186/s13054-024-05008-9

Cardiac arrest & resuscitation

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

Crit CarePublished 3 Jul 2024Systematic review and Bayesian meta-analysis of randomised trials

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Authors' 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.

Study context

Population: Patients with refractory OHCA3 RCTs
Participants: 209 vs 211

Comparison: Extracorporeal cardiopulmonary resuscitation (ECPR)-based treatment vs conventional CPR
ECPRn = 209
Conventional CPRn = 211reference
Outcome: Neurologically favorable survival, all rhythms
Follow-up: 6 months

Methodological detailsBayesian hierarchical random-effects model, vague priors, preregistered

Bayesian hierarchical random-effects model
Vague priors
Preregistered

Pooled result

As reported in the abstract

ECPR vs Conventional CPRMedian relative risk (95% CrI)

CrI

1.47(0.73–3.32)

ECPR vs Conventional CPRMean absolute risk difference (95% CrI)

ECPR

8.7%(- 5.0; 42.7%)

Posterior probability of absolute risk difference > 0%: 91.0%
Posterior probability of absolute risk difference > 5%: 71.1%

Further pooled results

Outcome		Median RR (95% CrI)
6-month neurologically favorable survival (shockable rhythms subgroup) · 6 monthsECPR vs Conventional CPR · CrI	0.20.5125	1.54 (0.79–3.71)
	0.20.5125Median relative risk (log scale)

Outcome		Mean absolute risk difference (95% CrI)
6-month neurologically favorable survival (shockable rhythms subgroup) · 6 monthsECPR vs Conventional CPR · CrI	−50050100	10.8% (- 4.2; 73.9%)
	−50050100Difference (linear scale)

6-month neurologically favorable survival (shockable rhythms subgroup) — Posterior probability of absolute risk difference > 0%: 92.4%
6-month neurologically favorable survival (shockable rhythms subgroup) — Posterior probability of absolute risk difference > 5%: 75.8%

Original publication

Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis. Crit Care. Published 3 July 2024. doi:10.1186/s13054-024-05008-9

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