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. 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. 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. 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. INPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060 ).

中文翻译：

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难治性院外心脏骤停的体外心肺复苏与标准治疗：贝叶斯荟萃分析


使用频率主义方法检查了几项关于难治性院外心脏骤停患者体外心肺复苏 （ECPR） 的随机试验的结果，导致基于 p 值而不是临床相关治疗效果的概率对结果进行二分法解释。为了确定临床相关的基于 ECPR 的治疗对神经系统结局的影响的这种可能性，这些试验的作者对全部随机 ECPR 证据进行了贝叶斯荟萃分析。对 3 个电子数据库进行了系统检索。纳入了比较基于 ECPR 的治疗与常规 CPR 治疗难治性院外心脏骤停的随机试验。该研究已在 INPLASY （INPLASY2023120060） 中预先注册。主要贝叶斯分层荟萃分析估计了所有心律患者 6 个月神经学良好生存率的差异，次要分析评估了可电击心律患者的这种差异（贝叶斯分层随机效应模型）。初级贝叶斯分析是在模糊的先验下进行的。结局被表述为估计的中位相对风险、平均绝对风险差异和需要治疗的人数以及相应的 95% 可信区间 （CrI）。估计各种临床相关绝对风险差异阈值的后验概率。分析中纳入了 3 项随机试验 （ECPR，n = 209 名患者;常规 CPR，n = 211 名患者）。估计 6 个月神经系统良好生存率的 ECPR 中位相对风险为 1.47 （95%CrI 0.73-3.32），所有心律患者的平均绝对风险差为 8.7% （- 5.0;42.7%），中位相对风险为 1。54 （95%CrI 0.79-3.71），在可电击心律患者中，平均绝对风险差为 10.8% （95%CrI - 4.2;73.9%）。所有心律患者绝对风险差异 > 0% 和 > 5% 的后验概率分别为 91.0% 和 71.1%，可电击心律患者的后验概率分别为 92.4% 和 75.8%。目前的贝叶斯荟萃分析发现，临床相关的基于 ECPR 的治疗对具有所有心律和可电击心律的患者 6 个月神经学良好生存率的后验概率分别为 71.1% 和 75.8%。这些结果必须在报告的可信区间和随机试验的不同设计的背景下进行解释。INPLASY（INPLASY2023120060,2023 年 12 月 14 日，https://doi.org/10.37766/inplasy2023.12.0060 年）。