Extracorporeal life support in cardiac arrest: a post hoc Bayesian re-analysis of the INCEPTION trial
We analysed survival with a favourable neurologic outcome at 30 days and 6 months under a minimally informative prior in the intention-to-treat population …
Systematic Review, Meta-analysis, Randomised Trial
Abstract
Previously, we performed the multicentre INCEPTION trial, randomizing patients with refractory out-of-hospital cardiac arrest (OHCA) to extracorporeal cardiopulmonary resuscitation (ECPR) or conventional cardiopulmonary resuscitation (CCPR). Frequentist analysis showed no statistically significant treatment effect for the primary outcome; \(30\)-day survival with a favourable neurologic outcome (cerebral performance category score of \(1-2\)). To facilitate a probabilistic interpretation of the results, we present a Bayesian re-analysis of the INCEPTION trial.
We analysed survival with a favourable neurologic outcome at \(30\) days and \(6\) months under a minimally informative prior in the intention-to-treat population. Effect sizes are presented as absolute risk differences (ARDs) and relative risks (RRs), with \(95\%\) credible intervals (CrIs). We estimated posterior probabilities at various thresholds, including the minimal clinically important difference (MCID) (\(5\%\) ARD), based on expert consensus, and performed sensitivity analyses under sceptical and literature-based priors. The mean ARD for 30-day survival with a favourable neurologic outcome was \(3.6\%\) (\(95\%\) CrI \(-9.5-16.7\%\)), favouring ECPR, with a median RR of \(1.22\) (\(95\%\) CrI \(0.59-2.51\)). The posterior probability of an MCID was \(42\%\) at \(30\) days and \(42\%\) at \(6\) months, in favour of ECPR.
Citation
@online{gabrio2023,
author = {Gabrio, Andrea},
title = {Extracorporeal Life Support in Cardiac Arrest: A Post Hoc
{Bayesian} Re-Analysis of the {INCEPTION} Trial},
volume = {13},
number = {2},
date = {2023-10-05},
url = {https://academic.oup.com/ehjacc/article/13/2/191/7328929},
doi = {10.1093/ehjacc/zuad130},
langid = {en},
abstract = {{[}We analysed survival with a favourable neurologic
outcome at 30 days and 6 months under a minimally informative prior
in the intention-to-treat population ...{]}\{style=“font-size:
85\%”\}}
}