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Editorial| Volume 182, 109666, January 2023

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The case for causal inference methods in resuscitation research

Published:December 20, 2022DOI:https://doi.org/10.1016/j.resuscitation.2022.12.004
The case for causal inference methods in resuscitation research
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      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).
      Resuscitation. 2020; 152: 39-49https://doi.org/10.1016/j.resuscitation.2020.02.044
      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.
      Resuscitation. 2021; 161: 1-60https://doi.org/10.1016/j.resuscitation.2021.02.003
      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).
      Resuscitation. 2020; 152: 39-49https://doi.org/10.1016/j.resuscitation.2020.02.044
      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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      References

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        • Okubo M.
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        • et al.
        Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR).
        Resuscitation. 2020; 152: 39-49https://doi.org/10.1016/j.resuscitation.2020.02.044
        View in Article

      2. 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.

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      Article info

      Publication history

      Published online: December 20, 2022
      Accepted: December 7, 2022
      Received: December 5, 2022

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2022.12.004

      Copyright

      © 2022 Elsevier B.V. All rights reserved.

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