What change in outcomes after cardiac arrest is necessary to change practice? Results of an international survey

Graham Nichol, Siobhan P. Brown, Gavin D. Perkins, Francis Kim, Fritz Sterz, Jo Ann Broeckel Elrod, Spyros Mentzelopoulos, Richard Lyon, Yaseen Arabi, Maaret Castren, Peter Larsen, Terence D Valenzuela, Jan Thorsten Graesner, Scott Youngquist, Nalinas Khunkhlai, Henry E. Wang, Franek Ondrej, Juan Manuel Fraga Sastrias, Anders Barasa, Michael R. Sayre

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background Efficient trials of interventions for patients with out-of-hospital cardiac arrest (OHCA) should have adequate but not excess power to detect a difference in outcomes. The minimum clinically important difference (MCID) is the threshold value in outcomes observed in a trial at which providers should choose to adopt a treatment. There has been limited assessment of MCID for outcomes after OHCA. Therefore, we conducted an international survey of individuals interested in cardiac resuscitation to define the MCID for a range of outcomes after OHCA. Methods A brief survey instrument was developed and modified by consensus. Included were open-ended responses. The survey included an illustrative example of a hypothetical randomized study with distributions of outcomes based on those in a public use datafile from a previous trial. Elicited information included the minimum significant difference required in an outcome to change clinical practice. The population of interest was emergency physicians or other practitioners of acute cardiovascular research. Results Usable responses were obtained from 160 respondents (50% of surveyed) in 46 countries (79% of surveyed). MCIDs tended to increase as baseline outcomes increased. For a population of patients with 25% survival to discharge and 20% favorable neurologic status at discharge, the MCID were median 5 (interquartile range [IQR] 3, 10) percent for survival to discharge; median 5 (IQR 2, 10) percent for favorable neurologic status at discharge, median 4 (IQR 2, 9) days of ICU-free survival and median 4 (IQR 2, 8) days of hospital-free survival. Conclusion Reported MCIDs for outcomes after OHCA vary according to the outcome considered as well as the baseline rate of achieving it. MCIDs of ICU-free survival or hospital-free survival may be useful to accelerate the rate of evidence-based change in resuscitation care.

Original languageEnglish (US)
Pages (from-to)115-120
Number of pages6
JournalResuscitation
Volume107
DOIs
StatePublished - Oct 1 2016

Keywords

  • Cardiac arrest
  • Methods
  • Randomized trails
  • Survey

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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    Nichol, G., Brown, S. P., Perkins, G. D., Kim, F., Sterz, F., Broeckel Elrod, J. A., Mentzelopoulos, S., Lyon, R., Arabi, Y., Castren, M., Larsen, P., Valenzuela, T. D., Graesner, J. T., Youngquist, S., Khunkhlai, N., Wang, H. E., Ondrej, F., Sastrias, J. M. F., Barasa, A., & Sayre, M. R. (2016). What change in outcomes after cardiac arrest is necessary to change practice? Results of an international survey. Resuscitation, 107, 115-120. https://doi.org/10.1016/j.resuscitation.2016.08.004