Editorials

Improving outcomes from in-hospital cardiac arrest

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1858 (Published 06 April 2016) Cite this as: BMJ 2016;353:i1858
  1. Keith Couper, postdoctoral research fellow1 2,
  2. Gavin D Perkins, professor1 2
  1. 1Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
  2. 2Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to: G D Perkins g.d.perkins{at}warwick.ac.uk

Make sure local practice is informed by the latest guidelines

Over 200 000 adults a year sustain a cardiac arrest while in hospital in the United States.1 Most trials have taken place outside hospital,2 yet the etiology, patient characteristics, time to treatment, and outcomes are quite different from cardiac arrests occurring in inpatients. Clinical guidelines for in-hospital resuscitation are therefore mainly drawn from the extrapolation of findings from out-of-hospital trials, observational studies, and consensus of expert opinion coordinated through the International Liaison Committee for Resuscitation.3

Given the cost, logistical, and ethical challenges of conducting randomized trials in cardiac arrest, the use of high quality observational data to provide insights into the effectiveness of treatments is attractive. The main limitation of observational studies is the risk that the outcome is affected by both the treatment allocation and other factors that influence the treatment allocation. Propensity scoring methods have been growing in popularity as a way of reducing confounding related to measured variables.

In critically ill patients, well conducted propensity score analyses generally agree with findings from randomized controlled …

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