Abstract 102: Out-of-Hospital Cardiac Arrest Clinical Trial Control Groups: Time Capsules for Discovery of Secular Trends---Fraction of Patients with Good Neurological Outcomes, 1985 to Present
Introduction: Over time there have been changes in consensus therapy for out of hospital cardiac arrest (OOHCA), including changes in BLS-ACLS, and recently targeted temperature management. There has been only limited success, however, in determining the effect of specific interventions on neurological outcome using randomized clinical trials (RCT’s) and registries.
Hypothesis: The control groups in OOHCA RCT’s can be utilized to identify the presence or absence of potential trends in neurological outcome related to secular changes in care.
Methods: Comprehensive online search for RCT’s in OOHCA with n > 50 in control group, and reporting neurological outcome, 1960 to present. Extraction of demographic and outcome variables. Analysis, fraction of resuscitated patients with good neurological outcome (GNO), defined as CPC 1 or 2 as a function of year.
Results: n=32 usable RCTS were identified, all since 1985. No significant trends in the fraction of patients with GNO were identified (Figure). There was relatively large variability. Outcomes in the epoch since the promulgation of hypothermia have not changed overall. However, since about 2012 there have been a handful of RCT’s with relatively high fraction of patients with GNO compared to historical norms.
Limitations: Retrospective methodology and background regional differences limits significance and applicability, hypothesis generating only.
Conclusion: Between 1985 and the present, there were no trends in GNO rates in the control groups of RCTs, possibly indicating lack of efficacy or toxicity with respect to therapies experiencing changing patterns of utilization, or an offsetting change in substrate.
Author Disclosures: K.M. Engerer: None. J.V. Coleman: None. L.F. Valle: None. M. Roginski: None. N.A. Paradis: None.
- © 2014 by American Heart Association, Inc.