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. 2024 Feb 16;13(2):191-200.
doi: 10.1093/ehjacc/zuad130.

Extracorporeal life support in cardiac arrest: a post hoc Bayesian re-analysis of the INCEPTION trial

Samuel Heuts  1   2 , Anina F van de Koolwijk  3 , Andrea Gabrio  4 , Johannes F H Ubben  3   5 , Iwan C C van der Horst  2   3 , Thijs S R Delnoij  3 , Martje M Suverein  3 , Jos G Maessen  1   2 , Roberto Lorusso  1   2 , Marcel C G van de Poll  3   6
Affiliations

Extracorporeal life support in cardiac arrest: a post hoc Bayesian re-analysis of the INCEPTION trial

Samuel Heuts et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

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).

Keywords: Bayesian analysis; Cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Out-of-hospital cardiac arrest; Randomized controlled trial.

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Conflict of interest statement

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.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Probability density function of a 30-day survival difference in favour of extracorporeal cardiopulmonary resuscitation under a minimally informative prior at various thresholds expressed as absolute risk difference and relative risk. ARD, absolute risk difference; AUC, area under the curve; CCPR, conventional cardiopulmonary resuscitation; ECPR, extracorporeal cardiopulmonary resuscitation; RR, relative risk.
Figure 2
Figure 2
Full posterior probability distributions for the effect of extracorporeal cardiopulmonary resuscitation treatment on 30-day survival with a favourable neurological outcome expressed in absolute risk difference (%) under a minimally informative prior. The dotted line represents the minimal clinically important difference (>5% absolute risk difference). ARD, absolute risk difference; CCPR, conventional cardiopulmonary resuscitation; ECPR, extracorporeal cardiopulmonary resuscitation.
Figure 3
Figure 3
Prior and posterior probability distributions of 30-day cerebral performance category score of 1–2 survival in patients undergoing extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest, based on different priors. Posterior probabilities of 30-day cerebral performance category score of 1–2 survival with extracorporeal cardiopulmonary resuscitation presented for (A) a minimally informative prior, (B) a sceptical prior, (C) a prior based on a recent meta-analysis, and (D) a prior based on the Prague out-of-hospital cardiac arrest trial. CPC, cerebral performance category; ECPR, extracorporeal cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest.
Figure 4
Figure 4
Prior and posterior probability distributions of 6-month cerebral performance category score of 1–2 survival in patients undergoing extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest, based on different priors. Posterior probabilities of 6-month cerebral performance category score of 1–2 survival with extracorporeal cardiopulmonary resuscitation presented for (A) a minimally informative prior, (B) a sceptical prior, (C) a prior based on a recent meta-analysis, and (D) a prior based on the Prague out-of-hospital cardiac arrest trial. CPC, cerebral performance category; ECPR, extracorporeal cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest.
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References

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