PMID- 37872725 OWN - NLM STAT- MEDLINE DCOM- 20240219 LR - 20240219 IS - 2048-8734 (Electronic) IS - 2048-8726 (Print) IS - 2048-8726 (Linking) VI - 13 IP - 2 DP - 2024 Feb 16 TI - Extracorporeal life support in cardiac arrest: a post hoc Bayesian re-analysis of the INCEPTION trial. PG - 191-200 LID - 10.1093/ehjacc/zuad130 [doi] AB - AIMS: Previously, we performed the multicentre INCEPTION trial, randomizing patients with refractory out-of-hospital cardiac arrest (OHCA) to extracorporeal cardiopulmonary resuscitation (ECPR) or conventional cardiopulmonary resuscitation (CCPR). Frequentist analysis showed no statistically significant treatment effect for the primary outcome; 30-day survival with a favourable neurologic outcome (cerebral performance category score of 1-2). To facilitate a probabilistic interpretation of the results, we present a Bayesian re-analysis of the INCEPTION trial. METHODS AND RESULTS: We analysed survival with a favourable neurologic outcome at 30 days and 6 months under a minimally informative prior in the intention-to-treat population. Effect sizes are presented as absolute risk differences (ARDs) and relative risks (RRs), with 95% credible intervals (CrIs). We estimated posterior probabilities at various thresholds, including the minimal clinically important difference (MCID) (5% ARD), based on expert consensus, and performed sensitivity analyses under sceptical and literature-based priors. The mean ARD for 30-day survival with a favourable neurologic outcome was 3.6% (95% CrI -9.5-16.7%), favouring ECPR, with a median RR of 1.22 (95% CrI 0.59-2.51). The posterior probability of an MCID was 42% at 30 days and 42% at 6 months, in favour of ECPR. CONCLUSION: Bayesian re-analysis of the INCEPTION trial estimated a 42% probability of an MCID between ECPR and CCPR in refractory OHCA in terms of 30-day survival with a favourable neurologic outcome. TRIAL REGISTRATION: Clinicaltrials.gov (NCT03101787, registered 5 April 2017). CI - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. FAU - Heuts, Samuel AU - Heuts S AUID- ORCID: 0000-0003-3531-9997 AD - Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. AD - Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht 6229ER, The Netherlands. FAU - van de Koolwijk, Anina F AU - van de Koolwijk AF AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. FAU - Gabrio, Andrea AU - Gabrio A AD - Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, Maastricht 6229HA, The Netherlands. FAU - Ubben, Johannes F H AU - Ubben JFH AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. AD - Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. FAU - van der Horst, Iwan C C AU - van der Horst ICC AD - Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht 6229ER, The Netherlands. AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. FAU - Delnoij, Thijs S R AU - Delnoij TSR AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. FAU - Suverein, Martje M AU - Suverein MM AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. FAU - Maessen, Jos G AU - Maessen JG AD - Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. AD - Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht 6229ER, The Netherlands. FAU - Lorusso, Roberto AU - Lorusso R AUID- ORCID: 0000-0002-1777-2045 AD - Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. AD - Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht 6229ER, The Netherlands. FAU - van de Poll, Marcel C G AU - van de Poll MCG AD - Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229HX, The Netherlands. AD - School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, Maastricht 6229ER, The Netherlands. LA - eng SI - ClinicalTrials.gov/NCT03101787 GR - ZONMW_/ZonMw/Netherlands PT - Journal Article PL - England TA - Eur Heart J Acute Cardiovasc Care JT - European heart journal. Acute cardiovascular care JID - 101591369 SB - IM MH - Humans MH - Bayes Theorem MH - *Extracorporeal Membrane Oxygenation/methods MH - *Cardiopulmonary Resuscitation/methods MH - *Out-of-Hospital Cardiac Arrest/therapy MH - Probability MH - Retrospective Studies PMC - PMC10873541 OTO - NOTNLM OT - Bayesian analysis OT - Cardiopulmonary resuscitation OT - Extracorporeal membrane oxygenation OT - Out-of-hospital cardiac arrest OT - Randomized controlled trial COIS- Conflict of interest: R.L. reports consulting fees from Abiomed and participates in an advisory board of Xenios not related to this work. All other authors report no conflicts of interest. EDAT- 2023/10/24 06:41 MHDA- 2024/02/19 06:43 PMCR- 2023/10/24 CRDT- 2023/10/24 01:12 PHST- 2023/09/17 00:00 [received] PHST- 2023/10/17 00:00 [revised] PHST- 2023/10/19 00:00 [accepted] PHST- 2024/02/19 06:43 [medline] PHST- 2023/10/24 06:41 [pubmed] PHST- 2023/10/24 01:12 [entrez] PHST- 2023/10/24 00:00 [pmc-release] AID - 7328929 [pii] AID - zuad130 [pii] AID - 10.1093/ehjacc/zuad130 [doi] PST - ppublish SO - Eur Heart J Acute Cardiovasc Care. 2024 Feb 16;13(2):191-200. doi: 10.1093/ehjacc/zuad130.