Barry Williams

COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation

Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.

The size of the problem

have direct knowledge, is the size of the problem. There were certified for employment in the City of New York last year, the year ending July 31, nearly 52,000 children, under the age of sixteen years, to all of whom was issued what is known as a regular employment certificate. In addition there were issued during the months of July and August nearly ^6,000 vacation employment certificates. Any child over fourteen years of age who can prove that fact and who is in normally good health can obtain such vacation employment certificate. Of this large number of children who leave school to work the greater portion come from graduates of elementary schools and from children attending high schools. Until a few years -ago, the preponderance lay in the other direction, and the young people who obtained employment certificates came principally from the seventh and eighth grades of the elementary school. The emphasis has since been shifted. In 1920 somewhat more than 32,000 certificates were issued to elementary graduates and high school students and somewhat less than 20,000 were issued to children of the seventh and eighth grades. This does not of course include high school students above the age of sixteen who are likel to work in the summer without certificates. In the high schools there are now registered some 78,000 students, and of this number ab ut one-third are over sixteen years of ge.