What change in outcomes after cardiac arrest is necessary to change practice? Results of an international survey

Abstract

Reported MCIDs for outcomes after OHCA vary according to the outcome considered as well as the baseline rate of achieving it. MCIDs of ICU-free survival or hospital-free survival may be useful to accelerate the rate of evidence-based change in resuscitation care.

Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome

“…27 Patients who received advanced airway management were similar in the 2 groups (eTable 1 and eTable 2 in Supplement 2), and a strategy of using a supraglottic airway device first was associated with better outcomes whenever advanced airway management was undertaken by a trial paramedic (eTable 4); however, the between-group difference was less than the prespecified clinically important difference and less than the minimally important difference of approximately 3% reported by others. 28 The strategy of using a supraglottic airway device first also achieved initial ventilation success more often. Although The area of the squares is proportional to the number of patients included.…”

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

“…Neurological favourable outcome at discharge or 30 days is also a useful measure and is collected in many OHCA trials. The use of hospital-free survival, assessed as the number of days alive and out of hospital during the first 30 days post-arrest may provide statistical efficiency over dichotomous outcomes such as survival and favourable neurological outcome [93]. Although this is measurable and may reduce sample size requirements in costly randomised trials, like progression-free survival in cancer, there is controversy about the usefulness of this measure in cardiac arrest trials [94,95].…”

Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions

“…There may be value in further research to gain a better understanding of the characteristics, interpretation and statistical analysis of hospital free survival. 38 Strengths of this study include the prospective, randomised design, its independence from commercial sponsorship 39 and focus on long term outcomes. Nevertheless, this and similar studies face limitations which require the results to be interpreted with caution.…”