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The case for causal inference methods in resuscitation research

      Two thousand years ago, the Roman poet Ovid stated “Causa latet, vis est notissima” (i.e., the cause is hidden; the effect is visible to all). This may well still be true in resuscitation research. Outcomes following resuscitation after out-of-hospital cardiac arrest (OHCA) remain dismal, with a survival to hospital discharge rate of less than 20%.
      • Kiguchi T.
      • Okubo M.
      • Nishiyama C.
      • et al.
      Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR).
      The causes of persistently poor neurological outcomes despite decades of quality improvement efforts around OHCA are unclear. Given the potential for improvement, there exists a concerted global effort in the form of an almost continuous review of the evidence by members of the International Liaison Committee on Resuscitation (ILCOR) and summarised as consensus on science with treatment recommendations (CoSTR), which in turn inform periodic updates of the resuscitation guidelines such as the 2021 European Resuscitation Council guidelines.

      Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022;181:208–88.

      • Perkins G.D.
      • Gräsner J.-T.
      • Semeraro F.
      • et al.
      European Resuscitation Council Guidelines 2021: Executive summary.
      A recent report from analysis of 16 resuscitation registries identified nearly 6.5 fold differences in survival as well as neurological outcomes after CPR between the participating registries.
      • Kiguchi T.
      • Okubo M.
      • Nishiyama C.
      • et al.
      Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR).
      Despite reasonable harmonisation of data based on utstein-style elements, direct comparison between the different registries was not possible because of several confounders.
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