Also this year (check out last year top 10 trials), I systematically collected and summarized in this infographic 10 RCTs that I considered the most relevant landmark trials of 2022 in the fields of Cardiac Arrest, CPR and Resuscitation Science.
Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest
Ruijter BJ et al. N Engl J Med. 2022;386(8):724-734. Link
- Intervention: Suppressing rhythmic and periodic EEG activity with antiseizure medications for at least 48 hours vs. standard care alone
- Setting: Post-cardiac arrest (IHCA/OHCA)
- Sample: 172 patients
- Primary outcome: CPC score of 3, 4, or 5 at 3 months
- 90% vs 92% (2%; 95% CI −7% to 11%; P=0.68)
- Main findings: In comatose patients after cardiac arrest with rhythmic and periodic EEG activity, intensive antiseizure treatment for at least 48 hours did not improve neurologic outcomes at 3 months
Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
Belohlavek J et al. JAMA. 2022;327(8):737-747. Link
- Intervention: Early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment vs. continued ALS on site
- Setting: Intra-cardiac arrest (refractory OHCA)
- Sample: 256 patients
- Primary outcome: CPC score of 1 or 2 at 180 days
- 32% vs 22% (9.5%; 95% CI, −1.3% to 20.1%; P = 0.09)
- Main findings: In refractory OHCA, early intra-arrest transport, ECPR, and invasive assessment did not significantly improve survival with neurologically favorable outcome at 180 days
Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial
Hauw-Berlemont C et al. JAMA Cardiol. 2022;7(7):700-707. Link
- Intervention: Emergency vs. delayed (48 to 96 hours) coronary angiography (CAG) in survivors of an OHCA without ST-segment elevation on ECG
- Setting: Post-cardiac arrest (OHCA)
- Sample: 279
- Primary outcome: CPC score of 1 or 2 at 180 days
- 34% vs 31% (HR 0.87; 95% CI, 0.65-1.15; P = 0.32)
- Main findings: In patients resuscitated after OHCA without ST elevation, emergency CAG was not better than delayed CAG with respect to the 180-day survival rate with no or minimal neurologic sequelae
Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial
Bernard SA et al. JAMA. 2022;328(18):1818-1826. Link
- Intervention: Oxygen titration to achieve a saturation of 90-94% (intervention) vs. 98-100% (standard care) after ROSC and until arrival in the ICU
- Setting: Post-cardiac arrest (OHCA)
- Sample: 279 patients
- Primary outcome: Survival to hospital discharge
- 38% vs 48% (OR 0.68; 95% CI 0.46-1.00; P = 0.05)
- Main findings: Among OHCA patients with ROSC, targeting an O saturation of 90-94%, compared with 98-100%, until admission to the ICU did not significantly improve survival to discharge
Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest
Kjaergaard J et al. N Engl J Med. 2022;387(16):1456-1466. Link
- Intervention: MAP target of 63 mmHg vs 77 mmHg in comatose adults resuscitated from OHCA of cardiac cause
- Setting: Post-cardiac arrest (OHCA)
- Sample: 789 patients
- Primary outcome: Death or CPC of 3 or 4 at discharge within 90 day
- 34% vs 32% (HR 1.08; 95% CI, 0.84–1.37; P = 0.56)
- Main findings: Targeting a MAP of 77 or 63 mmHg in patients resuscitated from OHCA did not result in significantly different percentages of patients dying or having severe disability or coma
Oxygen Targets in Comatose Survivors of Cardiac Arrest
Schmidt H et al. N Engl J Med. 2022;387(16):1467-1476. Link
- Intervention: Restrictive oxygen target of a PaO of 9-10 kPa (68-75 mmHg) vs a liberal oxygen target of a PaO of 13-14 kPa (98-105 mmHg)
- Setting: Post-cardiac arrest (OHCA)
- Sample: 789 patients
- Primary outcome: Death or CPC of 3 or 4 at discharge within 90 day
- 32% vs 34% (HR 0.95; 95% CI, 0.75–1.21; P = 0.69)
- Main findings: Targeting of a restrictive or liberal oxygenation strategy in comatose patients after OHCA resulted in a similar incidence of death or severe disability or coma
Duration of Device-Based Fever Prevention after Cardiac Arrest
Hassager C et al. N Engl J Med. 2022;10.1056/NEJMoa2212528. Link
- Intervention: Temperature control at 36°C for 24h followed by device-based fever prevention (target 37°C) until 12h or awakening vs until 48h or awakening
- Setting: Post-cardiac arrest (OHCA)
- Sample: 393 patients
- Primary outcome: Death or CPC of 3 or 4 at discharge within 90 day
- 32% vs 34% (HR 0.99; 95% CI, 0.77–1.26; P = 0.70)
- Main findings: Active device-based fever prevention for 36 or 72 hours after OHCA did not result in significantly different percentages of patients dying or having severe disability or coma
Defibrillation Strategies for Refractory Ventricular Fibrillation
Cheskes S et al. N Engl J Med. 2022;387(21):1947-1956. Link
- Intervention: Standard vs vector-change (VC) vs double sequential external defibrillation (DSED) in patients who remained in VF after 3 shocks
- Setting: Intra-cardiac arrest (OHCA)
- Sample: 405 patients
- Primary outcome: Survival to hospital discharge
- 13% (standard) vs 22% (VC) vs 30% (DSED)
- aRR 1.71; 95% CI, 1.01–2.88(VC vs standard)
- aRR 2.21; 95% CI, 1.33–3.67 (DSED vs standard)
- Main findings: In patients with refractory ventricular fibrillation, survival to hospital discharge occurred more frequently with DSED or VC defibrillation than standard defibrillation
Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial
Wolfrum S et al. Circulation. 2022;146(18):1357-1366. Link
- Intervention: Hypothermic temperature control (32-34°C) for 24 h vs normothermia (≤37.5°C)
- Setting: Post-cardiac arrest (IHCA)
- Sample: 249 patients
- Primary outcome: All-cause mortality at 180 days
- 73% vs 71% (RR 1.03; 95% CI, 0.79–1.40; P = 0.82)
- Main findings: Hypothermic temperature control as compared with normothermia did not improve survival nor functional outcome at day 180 in patients with coma after IHCA
Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial
Berglund E et al. JAMA Cardiol. 2022;e224362. Link
- Intervention: Smartphone dispatch of volunteer responders to retrieve nearest AED on their way to the OHCA vs to go directly to the OHCA to perform CPR
- Setting: Intra-cardiac arrest (OHCA)
- Sample: 461 patients
- Primary outcome: Bystander-attached AED
- 13% vs 9.5% (RR 1.40; 95% CI 0.97-2.01; P = 0.08)
- Main findings: Smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase bystander AED use
Other interesting trials published in 2022
Kim JS, Ryoo SM, Kim YJ, et al. Augmented-Medication CardioPulmonary Resuscitation Trials in out-of-hospital cardiac arrest: a pilot randomized controlled trial. Crit Care. 2022;26(1):378. Published 2022 Dec 7. doi:10.1186/s13054-022-04248-x https://pubmed.ncbi.nlm.nih.gov/36476543/
Lee AF, Chien YC, Lee BC, et al. Effect of Placement of a Supraglottic Airway Device vs Endotracheal Intubation on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest in Taipei, Taiwan: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2022;5(2):e2148871. Published 2022 Feb 1. doi:10.1001/jamanetworkopen.2021.48871 https://pubmed.ncbi.nlm.nih.gov/35179588/
Mentzelopoulos SD, Pappa E, Malachias S, et al. Physiologic effects of stress dose corticosteroids in in-hospital cardiac arrest (CORTICA): A randomized clinical trial. Resusc Plus. 2022;10:100252. Published 2022 May 26. doi:10.1016/j.resplu.2022.100252 https://pubmed.ncbi.nlm.nih.gov/35652112/
Ghanbari Khanghah A, Moghadamnia MT, Panahi L, Pouy S, Aghajani Nargesi M, Kazemnezhad Leyli E. Effect of Interposed Abdominal Compression on Cardiopulmonary Resuscitation Outcomes; a Randomized Clinical Trial. Arch Acad Emerg Med. 2022;10(1):e57. Published 2022 Jul 16. doi:10.22037/aaem.v10i1.1678 https://pubmed.ncbi.nlm.nih.gov/36033983/
Supady A, Zahn T, Kuhl M, et al. Cytokine adsorption in patients with post-cardiac arrest syndrome after extracorporeal cardiopulmonary resuscitation (CYTER) – A single-centre, open-label, randomised, controlled trial. Resuscitation. 2022;173:169-178. doi:10.1016/j.resuscitation.2022.02.001 https://pubmed.ncbi.nlm.nih.gov/35143902/
Berve PO, Hardig BM, Skålhegg T, Kongsgaard H, Kramer-Johansen J, Wik L. Mechanical active compression-decompression versus standard mechanical cardiopulmonary resuscitation: A randomised haemodynamic out-of-hospital cardiac arrest study. Resuscitation. 2022;170:1-10. doi:10.1016/j.resuscitation.2021.10.026 https://pubmed.ncbi.nlm.nih.gov/34710550/
