A Bayesian Perspective Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest

Abstract

A recent randomized clinical trial, INCEPTION, reported in patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR (eCPR) and conventional CPR (cCPR) had similar effects on survival with a favorable neurologic outcome. The current study examines if a Bayesian perspective provides additional quantative insights. Depending on the prior selected, the Bayesian approach for the INCEPTION intentionto treat (ITT) analysis shows an equivalence probability between 13.4 - 16.8% (defined as 1 / 1.1 < odds ratio (OR) < 1.1). The probability of clinical superiority with eCPR ranges from 65.7 - 77.0 % (defined as OR > 1.1). A similar analyses using INCEPTION per protocol (PP) data shows an equivalence probability between 4.7 - 20.2% with reduced probabilities of clinical superiority not exceeding 25%. It is concluded that a Bayesian perspective allows considerable additional quantative insights into the trial analysis and interpretation. The non-negligible probabilities of increased survival, or even harm, with their considerable residual uncertainties, suggests that additional studies are required before concluding that eCPR and cCPR have similar average survival effects.