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

Abstract BackgroundWhether extracorporeal CPR (eCPR) has survival benefits over conventional CPR (cCPR) in patients with refractory out-of-hospital cardiac arrest is an unresolved clinical question. Objective: To determine if a Bayesian perspective provides additional quantative insights into a recently completed randomized clinical trial addressing this question. Methods: The INCEPTION trial of patients with refractory out-of-hospital cardiac arrest reported eCPR and cCPR had similar effects on survival with a favorable neurologic outcome. Herein the probability of eCPR superiority, equivalence or inferiority to cCPR is evaluated by Bayesian analyses using both vague and infromative priors. Results: Depending on the prior selected, the Bayesian reanalysis of the INCEPTION intention-to-treat data suggests 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 data shows an equivalence probability between 4.7 - 20.2% with reduced probabilities of clinical superiority not exceeding 25%. Conclusion: A Bayesian analysis allows additional quantative insights and suggests that more evidence is required before concluding that eCPR and cCPR have similar average survival effects.