Brian Connolly

Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital ‘Utstein Style’ A Statement for Healthcare Professionals From the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa

This scientific statement is the product of the Utstein ’95 Symposium held June 23-24, 1995, at Utstein Abbey, Island of Mosteroy, Rogaland County, Norway. Draft versions were circulated for comment to participants of the Utstein ’95 Symposium; the European Resuscitation Council Executive Committee; the Emergency Cardiac Care Committee of the American Heart Association; the Executive Committees of the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa; and several outside reviewers. The development of this statement was authorized by the Science Advisory and Coordinating Committee of the AHA and the Executive Committee of the European Resuscitation Council. We do not know the true effectiveness of in-hospital resuscitation. Observed results of the many published studies vary greatly. Studies originate from different settings and have different patient populations. Reports suffer from nonuniform nomenclature and variable inclusion definitions. Patients differ in the extent of comorbid conditions and interventions in place at the time of cardiac arrest. These differences prevent valid interhospital and intrahospital comparisons and make determining the effectiveness of current resuscitation techniques impossible. To develop these guidelines the task force used a consensus development process that originated with the “Utstein style” for reporting outcome data from out-of-hospital resuscitation events. Task force members performed an integrated review of published studies. An initial draft was prepared, discussed, and revised at a 2-day conference. Further drafts were revised and circulated among task force members and discussed face-to-face at three subsequent meetings. The task force defined a set of data elements that are essential or desirable for documenting in-hospital cardiac arrest. Data categories are hospital variables, patient variables, arrest variables, and outcome variables. The “In-Hospital Utstein-Style Template” was developed to summarize these data and recommendations for reporting a specific set of survival rates and outcomes. The task force …

Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: The in-hospital 'Utstein style'

This scientific statement is the product of the Utstein ’95 Symposium held June 23-24, 1995, at Utstein Abbey, Island of Mosteroy, Rogaland County, Norway. Draft versions were circulated for comment to participants of the Utstein ’95 Symposium; the European Resuscitation Council Executive Committee; the Emergency Cardiac Care Committee of the American Heart Association; the Executive Committees of the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa; and several outside reviewers. The development of this statement was authorized by the Science Advisory and Coordinating Committee of the AHA and the Executive Committee of the European Resuscitation Council. We do not know the true effectiveness of in-hospital resuscitation. Observed results of the many published studies vary greatly. Studies originate from different settings and have different patient populations. Reports suffer from nonuniform nomenclature and variable inclusion definitions. Patients differ in the extent of comorbid conditions and interventions in place at the time of cardiac arrest. These differences prevent valid interhospital and intrahospital comparisons and make determining the effectiveness of current resuscitation techniques impossible. To develop these guidelines the task force used a consensus development process that originated with the “Utstein style” for reporting outcome data from out-of-hospital resuscitation events. Task force members performed an integrated review of published studies. An initial draft was prepared, discussed, and revised at a 2-day conference. Further drafts were revised and circulated among task force members and discussed face-to-face at three subsequent meetings. The task force defined a set of data elements that are essential or desirable for documenting in-hospital cardiac arrest. Data categories are hospital variables, patient variables, arrest variables, and outcome variables. The “In-Hospital Utstein-Style Template” was developed to summarize these data and recommendations for reporting a specific set of survival rates and outcomes. The task force …

Special Resuscitation Situations An Advisory Statement From the International Liaison Committee on Resuscitation

### Background Children who require basic life support (BLS) and advanced life support (ALS) interventions account for 5% to 10% of all ambulance runs and approximately one quarter of emergency department visits in the United States. The principles, equipment, and drugs used for pediatric BLS and ALS are similar to those used for adults. However, the care of seriously ill or injured children requires specific knowledge of pediatric anatomy, physiology, and psychology plus practical pediatric expertise. ### Key Interventions to Prevent Arrest In infants and children, respiratory distress and failure is a much more common cardiac arrest etiology than sudden dysrhythmia or ventricular fibrillation. As a result, hypoxia, hypercarbia, and global ischemia often precede cardiac arrest. Critical organ perfusion is dependent on more rapid heart and respiratory rates than for adults. Therefore, additional attention is focused on early recognition and intervention for respiratory failure and shock, and less emphasis is placed on rapid early defibrillation than for adult cardiac arrest victims. ### BLS and ALS Interventions During Arrest Commentary on the specific application of BLS and ALS principles to pediatric patients is contained in the accompanying ILCOR pediatric advisory statements. 1. Tsai A, Kallsen G. Epidemiology of pediatric prehospital care. Ann Emerg Med . 1987;16:284-292. 2. Cummins RO, ed. Textbook of Advanced Cardiac Life Support. Dallas, Tex: American Heart Association; 1994:60-68. 3. Zaritsky A, Nadkarni V, Getson P, Kuehl K. CPR in children. Ann Emerg Med . 1987;16:1107-1111. ### Background Cardiac arrest due to electrolyte abnormalities is uncommon except in the case of hyperkalemia. Electrolyte concentrations change during cardiac arrest due to the rapidly changing acid-base status, catecholamine levels, and hypoxia. These changes do not require intervention unless the cardiac arrest is primarily caused by the electrolyte abnormality. ### Key Interventions to Prevent Arrest

The Universal Advanced Life Support Algorithm An Advisory Statement From the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation

Valid scientific evidence supports only three interventions as unequivocally effective in adult cardiac resuscitation: The universal algorithm presents these interventions simplistically and recommends a specific sequence that rescuers should follow. The sequence of interventions is based, whenever possible, on sound scientific information. But there is a paucity of convincing human data on some aspects of resuscitation. Until such time as new information becomes available, the working group made no changes to well-established procedures but suggested some modifications on educational rather than scientific grounds. Cardiac arrest rhythms can be divided into two subsets: ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) and non-VF/VT. Non-VF/VT incorporates both asystole and pulseless electrical activity (PEA). The only difference in management between the two arrest rhythms is the need for rescuers to perform defibrillation for patients in VF/VT. Otherwise the actions and interventions are essentially the same: basic CPR, tracheal intubation, epinephrine administration, and correction of reversible causes. …

Der innerklinische Utstein-Style (Teil II)

Diese wissenschaftliche Stellungnahme der American Heart Association, des European Resuscitation Council, der Heart And Stroke Foundation of Canada, des Australian Resuscitation Council und des Resuscitation Council of Southern Africa ist das Ergebnis des 95er Utstein Symposions, das vom 23.–24.06.1995 in der Utstein Abtei auf der Insel Mosteroy im Rogaland County in Norwegen stattfand.Der erste Teil dieser Stellungnahme wurde in der letzten Ausgabe von Notfall & Rettungsmedizin (2/98) publiziert.