In a recent study led by the University of Michigan, just 92 randomized control trials were found to have been conducted on immediate treatments for cardiac arrest over the past 20 years — a disproportionately low number given the 535,000 cases of cardiac arrest per year.

A University press release said although cardiac arrest kills 10 times more people in the United States than breast cancer, there is an immense lack of research aimed at treatment and survival of patients who experience cardiac arrest.

Shashank Sinha, a third-year general cardiology fellow at the University Health System who was the lead researcher of the study, said the amount of research is unacceptably low, noting fewer than five randomized control trials were published annually over the past 20 years.

“What we found in a nutshell was a striking paucity of randomized clinical trials relative to the burden of cardiac arrest in this country,” he said.

Working with a comprehensive team of cardiologists and health care workers, Sinha’s project aimed to address gaps in the current evidence and literature in the field. After many months, he said his team designed a comprehensive systematic review of randomized control trials, that has included 65,000 patients to date, for immediate treatments of cardiac arrest. 

Sinha said there are 25 to 86 times more published clinical trials for other diseases, including heart attacks and stroke.

“What we found here was an opportunity to try to better understand how we prioritize what the research needs are, to meet the public health burden of disease,” Sinha said.

He said the deficiency in research partly speaks to the availability of funding, systems for reporting results and the overall design of the studies.

In particular, Sinha’s team found a significant lack of focus on in-hospital cardiac arrests, happening more than 200,000 times a year. Despite their prevalence, there were only four randomized control trials over 20 years that looked at this particular patient population.

“I think part of the challenge is recognizing where the opportunities are, strategically, to help optimize the care for these very high risk and vulnerable patients,” Sinha said.

Internal Medicine Prof. Brahmajee Nallamothu, cardiologist for the University and the Ann Arbor Veterans Affairs Medical Center and co-author of the study, said the study of in-hospital cardiac arrests remains difficult, serving as an obstacle in developing effective treatments.

“The question is how can we change our model for how we study this condition, and how we can do things that will be meaningful in terms of evaluating therapies that could help,” Nallamothu said. “It’s tough in two ways — it’s tough because it’s hard to study, and then it’s a tough problem in terms of finding solutions.

Though past research has primarily focused on survival numbers, Sinha’s team aimed to shift that paradigm by looking more at the patient’s quality of life after cardiac arrest.

“I think the goals for our systematic review was to help inform the literature about whether it is possible to standardize how we measure the outcomes of care and focus… more on patient-centered outcomes, like returning to work, or having a reasonable quality of life, as opposed to simply whether they survive,” he said.

Nallamothu also emphasized providing more effective education on immediate treatments for cardiac arrest, like a CPR outreach event fellow project member Robert Neumar, an emergency medicine professor, held at a Department of Emergency Medicine tailgate last year where a video was played of team members giving CPR demonstrations.

“I think for me, the message to the community is always to try to improve education around basic life support and CPR,” Nallamothu said. “Bystander CPR is so critical to outcomes, that as well as early access to AEDs. Those are two community based solutions.”

Sinha said the research he is conducting should help lead to standardization and eventual accreditation of hospital care for immediate cardiac arrest treatment, like the current existing methods for stroke and heart attack.

“I think we’re still several years removed from that, but I hope that our study helps guide resuscitation research on where the priorities should be,” he said.

He said his team also hopes to galvanize interest from national organizations in the United States on this area of research because most trials on cardiac arrest have been done outside the country.

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