Toy Jake, Friend Lauren, Wilhelm Kelsey, Kim Michael, Gahm Claire, Panchal Ashish R, Dillon David, Donofrio-Odmann Joelle, Montroy Juan Carlos, Gausche-Hill Marianne, Bosson Nichole, Coute Ryan, Schlesinger Shira, Menegazzi James
Los Angeles County EMS Agency Santa Fe Springs California USA.
Department of Emergency Medicine Harbor-UCLA Medical Center Torrance California USA.
J Am Coll Emerg Physicians Open. 2024 Oct 17;5(5):e13334. doi: 10.1002/emp2.13334. eCollection 2024 Oct.
Despite the significant disease burden due to cardiac arrest, there is a relative paucity of randomized controlled trials (RCTs) to inform definitive management. We aimed to evaluate the current scope of cardiac arrest RCTs published between 2015 and 2022.
We conducted a search in October 2023 of MEDLINE, Embase, and Web of Science for cardiac arrest RCTs. We included trials published between 2015 and 2022 enrolling human subjects suffering from non-traumatic cardiac arrest. Descriptive statistics were reported and the Mann Kendall test was used to evaluate for temporal trends in the number of trials published annually.
We identified 1764 unique publications, 87 RCTs were included after title/abstract and full-text review. We found no significant increase in trials published annually (eight in 2015 and 16 in 2022, = 1.0). Geographic analysis of study centers found 31 countries represented; Denmark ( = 13, 15%) and the United States ( = 9, 10%) conducted the majority of trials. Nearly all trials included adults ( = 84, 97%) and few included children ( = 9, 10%). The majority of trials focused on out-of-hospital cardiac arrest ( = 62, 71%). Thirty-eight (44%) trials used an intervention characterized as a ; 28 (32%) interventions were characterized as a and 20 (23%) as a . Interventions were implemented with similar frequency in the prehospital (33%) and intensive care unit (38%) setting, as well as similarly between the intra-arrest (53%) and post-arrest (46%) periods. Twenty (27%) trials selected a primary outcome of survival at ≥ 28 days.
Publication of cardiac arrest RCTs remained constant between 2015 and 2022. We identified significant gaps including a lack of trials examining in-hospital cardiac arrest and pediatric patients.
尽管心脏骤停造成了重大疾病负担，但用于指导确定性治疗的随机对照试验（RCT）相对较少。我们旨在评估2015年至2022年间发表的心脏骤停RCT的当前范围。
我们于2023年10月在MEDLINE、Embase和科学网中检索心脏骤停RCT。我们纳入了2015年至2022年间发表的纳入非创伤性心脏骤停患者的试验。报告了描述性统计数据，并使用曼-肯德尔检验评估每年发表试验数量的时间趋势。
我们识别出1764篇独特的出版物，经标题/摘要和全文审查后纳入87项RCT。我们发现每年发表的试验数量没有显著增加（2015年为8项，2022年为16项，τ = 1.0）。对研究中心的地理分析发现涉及31个国家；丹麦（n = 13，15%）和美国（n = 9，10%）开展的试验最多。几乎所有试验都纳入了成人（n = 84，97%），很少有试验纳入儿童（n = 9，10%）。大多数试验聚焦于院外心脏骤停（n = 62，71%）。38项（44%）试验使用了一种被描述为 的干预措施；28项（32%）干预措施被描述为 ，20项（23%）被描述为 。干预措施在院前（概率33%）和重症监护病房（概率38%）环境中的实施频率相似，在心脏骤停期间（概率53%）和心脏骤停后（概率46%）期间也相似。20项（27%）试验选择≥28天存活作为主要结局。
2015年至2022年间心脏骤停RCT的发表数量保持稳定。我们发现了重大差距，包括缺乏针对院内心脏骤停和儿科患者的试验。
