Dataset Information

Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review.

ABSTRACT:

Objectives

To identify the risk of bias of randomised controlled trials (RCTs) referenced in the 2015 American Heart Association (AHA) guidelines update for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).

Design

A cross-sectional review.

Setting

All RCTs cited as references in the 2015 AHA guidelines update for CPR and ECC were extracted. After excluding non-human trials, studies that analysed existing RCTs, and RCTs published in a letter format, two reviewers assessed the risk of bias among RCTs included in this study.

Outcome measures

The Cochrane Collaboration's tool for assessing the risk of bias in six domains (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data and selective reporting) was used.

Results

Two hundred seventy-three RCTs were selected for the analyses. Of these RCTs, 78.8% had a high risk of bias for blinding of participants and personnel, mostly (87.7%) non-drug trials. In drug trials, the proportion of trials with a low risk of bias for blinding of participants and personnel was 73.0%. The proportion of RCTs with an unclear risk of bias were higher for random sequence generation (38.5%) and allocation concealment (34.1%) than in other domains. Unclear risk of bias proportions was 65.4% for random sequence generation and 57.7% for allocation concealment before the introduction of Consolidated Standards of Reporting Trials (CONSORT) but decreased to 31.3% and 32.2% after the 2010 CONSORT update, respectively.

Conclusions

The proportion of RCTs with an unclear risk of bias was still high for random sequence generation and allocation concealment in the 2015 AHA guidelines for CPR and ECC. The risk of bias should be considered when interpreting and applying the CPR guidelines. Authors should plan and report their research using CONSORT guidelines and the Cochrane Collaboration's tool to reduce the risk of bias.

SUBMITTER: Cho Y

PROVIDER: S-EPMC6502002 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review.

Cho Yongil Y Kim Changsun C Kang Bossng B

BMJ open 20190505 5

<h4>Objectives</h4>To identify the risk of bias of randomised controlled trials (RCTs) referenced in the 2015 American Heart Association (AHA) guidelines update for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).<h4>Design</h4>A cross-sectional review.<h4>Setting</h4>All RCTs cited as references in the 2015 AHA guidelines update for CPR and ECC were extracted. After excluding non-human trials, studies that analysed existing RCTs, and RCTs published in a letter format ...[more]

PMID: 31061016

Similar Datasets

Project description:BACKGROUND:Evidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite advances in resuscitation science and survival improvement over the last decades, only approximately 38% of children survive to hospital discharge after in-hospital cardiac arrest and only 6%-20% after out-of-hospital cardiac arrest. OBJECTIVE:We investigated whether a mobile app developed as a guide to support and drive CPR providers in real time through interactive pediatric advanced life support (PALS) algorithms would increase adherence to AHA guidelines and reduce the time to initiation of critical life-saving maneuvers compared to the use of PALS pocket reference cards. METHODS:This study was a randomized controlled trial conducted during a simulation-based pediatric cardiac arrest scenario caused by pulseless ventricular tachycardia (pVT). A total of 26 pediatric residents were randomized into two groups. The primary outcome was the elapsed time in seconds in each allocation group from the onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, including the time intervals between defibrillation attempts and drug doses, shock doses, and the number of shocks. All outcomes were assessed for deviation from AHA guidelines. RESULTS:Mean time to the first defibrillation attempt (121.4 sec, 95% CI 105.3-137.5) was significantly reduced among residents using the app compared to those using PALS pocket cards (211.5 sec, 95% CI 162.5-260.6, P<.001). With the app, 11 out of 13 (85%) residents initiated chest compressions within 60 seconds from the onset of pVT and 12 out of 13 (92%) successfully defibrillated within 180 seconds. Time to all other defibrillation attempts was reduced with the app. Adherence to the 2018 AHA pVT algorithm improved by approximately 70% (P=.001) when using the app following all CPR sequences of action in a stepwise fashion until return of spontaneous circulation. The pVT rhythm was recognized correctly in 51 out of 52 (98%) opportunities among residents using the app compared to only 19 out of 52 (37%) among those using PALS cards (P<.001). Time to epinephrine injection was similar. Among a total of 78 opportunities, incorrect shock or drug doses occurred in 14% (11/78) of cases among those using the cards. These errors were reduced to 1% (1/78, P=.005) when using the app. CONCLUSIONS:Use of the mobile app was associated with a shorter time to first and subsequent defibrillation attempts, fewer medication and defibrillation dose errors, and improved adherence to AHA recommendations compared with the use of PALS pocket cards.

Dataset Information

Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review.

Objectives

Design

Setting

Outcome measures

Results

Conclusions

Publications

Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review.

Similar Datasets

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