Evaluating the current breadth of randomized control trials on cardiac arrest: A scoping review.

Objectives: Despite the significant disease burden due to cardiac arrest, there is a relative paucity of randomized controlled trials (RCTs) to inform definitive management. We aimed to evaluate the current scope of cardiac arrest RCTs published between 2015 and 2022.

Methods: We conducted a search in October 2023 of MEDLINE, Embase, and Web of Science for cardiac arrest RCTs. We included trials published between 2015 and 2022 enrolling human subjects suffering from non-traumatic cardiac arrest. Descriptive statistics were reported and the Mann Kendall test was used to evaluate for temporal trends in the number of trials published annually.

Results: We identified 1764 unique publications, 87 RCTs were included after title/abstract and full-text review. We found no significant increase in trials published annually (eight in 2015 and 16 in 2022,  = 1.0). Geographic analysis of study centers found 31 countries represented; Denmark ( = 13, 15%) and the United States ( = 9, 10%) conducted the majority of trials. Nearly all trials included adults ( = 84, 97%) and few included children ( = 9, 10%). The majority of trials focused on out-of-hospital cardiac arrest ( = 62, 71%). Thirty-eight (44%) trials used an intervention characterized as a ; 28 (32%) interventions were characterized as a and 20 (23%) as a . Interventions were implemented with similar frequency in the prehospital (33%) and intensive care unit (38%) setting, as well as similarly between the intra-arrest (53%) and post-arrest (46%) periods. Twenty (27%) trials selected a primary outcome of survival at ≥ 28 days.

Conclusions: Publication of cardiac arrest RCTs remained constant between 2015 and 2022. We identified significant gaps including a lack of trials examining in-hospital cardiac arrest and pediatric patients.