Evaluating the alignment of recent cardiac arrest randomized controlled trials with the top resuscitation science knowledge gaps

Objective: To determine if recently published cardiac arrest randomized controlled trials (RCTs) align with and address the top scientific gaps previously identified in the American Heart Association (AHA) cardiac arrest treatment guidelines. Methods: All RCTs involving human subjects experiencing non-traumatic cardiac arrest, published between January 1, 2015, and December 31, 2022, were identified through searches in MEDLINE, Embase, and Web of Science. Abstracts or full manuscripts were individually reviewed and categorized according to the themes and rationale for the most urgent knowledge gaps in the 2015 AHA cardiac arrest guidelines published by Panchal et al. The data were analyzed descriptively. Results: A total of 87 cardiac arrest RCTs were identified over the study period. Most trials included the adult population (84, 96.5%) and out-of-hospital cardiac arrest (62, 71.3%). The RCTs addressed the following top scientific gaps: optimization of post-cardiac arrest care (40, 46.0%), optimal airway management strategies (9, 10.3%), hemodynamic monitoring/goal-directed resuscitation (1, 1.1%), dispatch-directed CPR (1, 1.1%), individualizing resuscitation strategies (1, 1.1%), and novel technology for out-of-hospital cardiac arrest identification and response (1, 1.1%). Recognized gaps in early neuroprognostication, optimizing educational strategies for providers, and prediction of patients at risk of cardiac arrest were not specifically addressed. A total of 34 RCTs (39.1%) targeted other knowledge gaps outside of the top 10. Conclusion: More than half of cardiac arrest RCTs published since 2015 have focused on optimizing post-resuscitative care or airway management strategies, leaving a disparity among other well-recognized knowledge gaps in the AHA cardiac arrest treatment guidelines.