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      Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations ☆

      research-article
      Author(s): , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1
      Publication date (Electronic):
      Journal: Resuscitation
      Publisher: Published by Elsevier B.V.
      Keywords: AHA Scientific Statements, arrhythmias, cardiopulmonary arrest, cardiopulmonary resuscitation and emergency cardiac care, echocardiography, post-cardiac arrest care, postresuscitation care, prognostication, sudden cardiac arrest, ventricular fibrillation

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          Abstract

          This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

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          European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support.

          Jasmeet Soar, Jerry P Nolan, Bernd W Böttiger … (2015)
          Article 0 comments Cited 350 times – based on 0 reviews     Review now
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            Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

            Niklas Nielsen, Jørn Wetterslev, Tobias Cronberg … (2014)
            Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.).
            Article 0 comments Cited 291 times – based on 0 reviews     Review now
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              Gray literature: An important resource in systematic reviews

              Arsenio Paez (2017)
              Systematic reviews aide the analysis and dissemination of evidence, using rigorous and transparent methods to generate empirically attained answers to focused research questions. Identifying all evidence relevant to the research questions is an essential component, and challenge, of systematic reviews. Gray literature, or evidence not published in commercial publications, can make important contributions to a systematic review. Gray literature can include academic papers, including theses and dissertations, research and committee reports, government reports, conference papers, and ongoing research, among others. It may provide data not found within commercially published literature, providing an important forum for disseminating studies with null or negative results that might not otherwise be disseminated. Gray literature may thusly reduce publication bias, increase reviews' comprehensiveness and timeliness, and foster a balanced picture of available evidence. Gray literature's diverse formats and audiences can present a significant challenge in a systematic search for evidence. However, the benefits of including gray literature may far outweigh the cost in time and resource needed to search for it, and it is important for it to be included in a systematic review or review of evidence. A carefully thought out gray literature search strategy may be an invaluable component of a systematic review. This narrative review provides guidance about the benefits of including gray literature in a systematic review, and sources for searching through gray literature. An illustrative example of a search for evidence within gray literature sources is presented to highlight the potential contributions of such a search to a systematic review. Benefits and challenges of gray literature search methods are discussed, and recommendations made.
              Article 0 comments Cited 235 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Resuscitation
                Journal ID (iso-abbrev): Resuscitation
                Title: Resuscitation
                Publisher: Published by Elsevier B.V.
                ISSN (Print): 0300-9572
                ISSN (Electronic): 1873-1570
                Publication date PMC-release: 21 October 2020
                Publication date (Print): November 2020
                Publication date (Electronic): 21 October 2020
                Volume: 156
                Pages: A80-A119
                Author notes
                [1]

                The list of collaborators is given in the Acknowledgements.

                Article
                Publisher Item ID: S0300-9572(20)30460-3
                DOI: 10.1016/j.resuscitation.2020.09.012
                PMC ID: 7576326
                PubMed ID: 33099419
                SO-VID: eec575fa-c469-43af-aebf-d429c86265db
                Copyright © © 2020 Published by Elsevier B.V.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Article

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: aha scientific statements,arrhythmias,cardiopulmonary arrest,cardiopulmonary resuscitation and emergency cardiac care,echocardiography,post-cardiac arrest care,postresuscitation care,prognostication,sudden cardiac arrest,ventricular fibrillation
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: aha scientific statements, arrhythmias, cardiopulmonary arrest, cardiopulmonary resuscitation and emergency cardiac care, echocardiography, post-cardiac arrest care, postresuscitation care, prognostication, sudden cardiac arrest, ventricular fibrillation

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