Therein lies the problem- we will likely not know what their baseline is. Same goes with BP and using this for vasopressor titration (instead we use a universal MAP). How do we get around this?
Screams in diabetic...
Agree. Ahh, haloperidol, the teflon drug!
But this may also happen with non-RAR randomisation as well. Small centres that are low recruiters with a different demographic may have different outcomes to larger (metropolitan) centres. Most ICU trials are like this. It rarely gets spoken about, though.
And patients do get better care, regardless of which arm they are allocated. As for the breaches of trust, I can understand that. I come from a viewpoint that we should enrol every pt into a trial.
The effect on confounding doesn't apply here, as randomisation has nothing to do with confounders.
Centre effects are adjusted for (either through adjustment for stratification or as a random effect), but the missing arms may have more of an effect on allocation concealment/blinding (depending on the design). Whether this has much of an effect on the overall estimate 🤷♂️.
But REMAP-CAP is the biggest international BAPT program in the world, and mistakes will happen. They were transparent about it and discuss how they will minimise these risks in the future.