{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T04:38:50Z","timestamp":1769056730730,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Over the past two decades, advanced airway management, early coronary angiography, and therapeutic hypothermia have shaped post-out-of-hospital cardiac arrest (OHCA) care. However, recent large randomized trials have challenged these strategies and created substantial uncertainty leading to relevant guideline changes. This review focuses on the trials that ultimately influenced current guideline recommendations by downgrading previous recommendations. We determine how structural limitations may have affected the validity and interpretation of their results. The review critically evaluates the methodological design and execution of those trials. Despite neutral findings from recent randomized trials, use of advanced airway management during resuscitation, coronary angiography in patients with a high likelihood of acute coronary occlusion, and therapeutic hypothermia for comatose OHCA survivors still play a relevant role in post-resuscitation management.<\/jats:p>","DOI":"10.3390\/jcm15020821","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"821","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Critical Review on Misleading Evidence in Cardiac Arrest Trials\u2014Why Less Complexity Does Not Result in Better Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-6162","authenticated-orcid":false,"given":"Andreas","family":"Sch\u00e4fer","sequence":"first","affiliation":[{"name":"Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, D-30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9130-9470","authenticated-orcid":false,"given":"Tobias J.","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, D-30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, D-30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Garcheva","sequence":"additional","affiliation":[{"name":"Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, D-30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1001\/jama.2018.7044","article-title":"Effect of a Strategy of Initial Laryngeal Tube Insertion vs. Endotracheal Intubation on 72-Hour Survival in Adults with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial","volume":"320","author":"Wang","year":"2018","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1001\/jama.2018.11597","article-title":"Effect of a Strategy of a Supraglottic Airway Device vs. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial","volume":"320","author":"Benger","year":"2018","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1056\/NEJMoa003289","article-title":"Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia","volume":"346","author":"Bernard","year":"2002","journal-title":"N. 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