• Carolina S Romero, Esther Romero, Nicolò Maimieri, Maria Popp, Cristiano Marchetti, Gaetano Lombardi, Alessandro Ortalda, Alberto Zangrillo, and Giovanni Landoni.
• Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain; Division of Research Methodology, European University, Valencia, Spain; Department of Methods in Research, European University of Valencia, Valencia, Spain.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 3327-3333.

ObjectivesRandomized clinical trials (RCTs) represent the highest level of scientific evidence. The aim of this review was to map and summarize the main characteristics and publication trends of RCTs with a statistically significant effect on mortality in critically ill and perioperative patients.DesignA mapping review of RCTs published between January 1982 and January 2021. The authors searched PubMed/MEDLINE and EMBASE for RCTs reporting mortality data. A descriptive analysis was conducted, including general and methodologic information of all these RCTs with a statistically significant difference (p < 0.05) in mortality.Measurements And Main ResultsThe authors identified 340 studies published in 115 journals from 42 countries. The most represented clinical areas were ventilatory support (n = 58, 17%) and hemodynamics (n = 56, 16%). A detrimental effect on survival was described in 47 (14%) RCTs. Denmark had the highest number of published trials per million inhabitants. A total of 40 (12%) RCTs were led by a female author. The intention-to-treat principle was applied overall in 60% of RCTs, though this percentage increased up to 75% when the study was published in journals with high impact factor.ConclusionsIn the largest contemporary RCTs database of interventions significantly influencing mortality, the authors found an increase in scientific production. United States, China, France, Italy, and the United Kingdom contributed with 172 (51%) RCTs over 40 years. Only 20% of the studies were multinational collaborations, though this percentage increased over time. The presence of women as first authors was 1 out of 8 RCTs.Copyright © 2022 Elsevier Inc. All rights reserved.

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