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Abstract：
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.
CONCLUSIONS: 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.
BACKGROUND: INPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060 ).
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.
CONCLUSIONS: 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.
BACKGROUND: INPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060 ).
摘要：
背景：对难治性院外心脏骤停患者进行体外心肺复苏（ECPR）的几项随机试验的结果进行了检查，根据p值而不是临床相关治疗效果的可能性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果的影响的概率，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.
方法：对三个电子数据库进行了系统检索。包括比较基于ECPR的治疗与常规CPR治疗难治性院外心脏骤停的随机试验。该研究在INPLASY（INPLASY2023120060）中进行了预注册。主要的贝叶斯分层荟萃分析估计了所有节律患者的6个月神经有利生存率的差异，次要分析评估了具有可电击节律的患者的这种差异（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。结果被表述为估计的中位数相对风险，平均绝对风险差异，以及需要以相应的95%可信间隔(CrIs)治疗的数字。估计了各种临床相关绝对风险差异阈值的后验概率。
结果：分析中包括三项随机试验（ECPR，n=209例；常规CPR，n=211名患者）。在所有节律的患者中，ECPR在6个月的神经系统有利生存中的估计中位相对风险为1.47（95％CrI0.73-3.32），平均绝对风险差异为8.7％（-5.0;42.7％），和中位数相对风险为1.54（95%CrI0.79-3.71），平均绝对风险差异为10.8%（95%CrI-4.2；73.9%）。在所有节律的患者中，绝对风险差异>0％和>5％的后验概率分别为91.0％和71.1％，在可电击节律的患者中分别为92.4％和75.8％。分别。
结论：当前的贝叶斯荟萃分析发现，在所有节律和可电击节律的患者中，临床相关的基于ECPR的治疗效果对6个月的神经系统有利生存率分别为71.1%和75.8%。这些结果必须在报告的可信间隔和随机试验的不同设计的背景下进行解释。
背景：插入（INPLASY2023120060，12月14日，2023年，https://doi.org/10.37766/inplasy2023.12.0060）。
方法：对三个电子数据库进行了系统检索。包括比较基于ECPR的治疗与常规CPR治疗难治性院外心脏骤停的随机试验。该研究在INPLASY（INPLASY2023120060）中进行了预注册。主要的贝叶斯分层荟萃分析估计了所有节律患者的6个月神经有利生存率的差异，次要分析评估了具有可电击节律的患者的这种差异（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。结果被表述为估计的中位数相对风险，平均绝对风险差异，以及需要以相应的95%可信间隔(CrIs)治疗的数字。估计了各种临床相关绝对风险差异阈值的后验概率。
结果：分析中包括三项随机试验（ECPR，n=209例；常规CPR，n=211名患者）。在所有节律的患者中，ECPR在6个月的神经系统有利生存中的估计中位相对风险为1.47（95％CrI0.73-3.32），平均绝对风险差异为8.7％（-5.0;42.7％），和中位数相对风险为1.54（95%CrI0.79-3.71），平均绝对风险差异为10.8%（95%CrI-4.2；73.9%）。在所有节律的患者中，绝对风险差异>0％和>5％的后验概率分别为91.0％和71.1％，在可电击节律的患者中分别为92.4％和75.8％。分别。
结论：当前的贝叶斯荟萃分析发现，在所有节律和可电击节律的患者中，临床相关的基于ECPR的治疗效果对6个月的神经系统有利生存率分别为71.1%和75.8%。这些结果必须在报告的可信间隔和随机试验的不同设计的背景下进行解释。
背景：插入（INPLASY2023120060，12月14日，2023年，https://doi.org/10.37766/inplasy2023.12.0060）。
