William H. Montgomery

Part 1: Executive Summary 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation (ILCOR) was founded on November 22, 1992, and currently includes representatives from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Council of Southern Africa (RCSA), the InterAmerican Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Its mission is to identify and review international science and knowledge relevant to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and when there is consensus to offer treatment recommendations. Emergency cardiovascular care includes all responses necessary to treat sudden life-threatening events affecting the cardiovascular and respiratory systems, with a particular focus on sudden cardiac arrest. In 1999, the AHA hosted the first ILCOR conference to evaluate resuscitation science and develop common resuscitation guidelines. The conference recommendations were published in the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care .1 Since 2000, researchers from the ILCOR member councils have evaluated resuscitation science in 5-year cycles. The conclusions and recommendations of the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations were published at the end of 2005.2,3 The most recent International Consensus Conference was held in Dallas in February 2010, and this publication contains the consensus science statements and treatment recommendations developed with input from the invited participants. The goal of every resuscitation organization and resuscitation expert is to prevent premature cardiovascular death. When cardiac arrest or life-threatening emergencies occur, prompt and skillful response can make the difference between life and death and between intact survival and debilitation. This document summarizes the 2010 evidence evaluation of published science about the recognition and response to sudden life-threatening events, particularly sudden cardiac arrest and periarrest events in …

Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library). By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6 GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9 These evidence profile tables were then used to create a …

Single-Rescuer Adult Basic Life Support An Advisory Statement From the Basic Life Support Working Group of the International Liaison Committee on Resuscitation

This document presents the consensus view of the Basic Life Support (BLS) Working Group of the International Liaison Committee on Resuscitation (ILCOR), which represents the world’s major resuscitation organizations (including the American Heart Association [AHA], the Australian Resuscitation Council, the European Resuscitation Council [ERC], the Heart and Stroke Foundation of Canada, and the Resuscitation Councils of Southern Africa). These advisory statements have evolved during 10 meetings of ILCOR from 1991 to the present. The scientific basis for the treatment of cardiac arrest has an active international literature.1 The purpose of creating these advisory statements is to take full advantage of international perspective and experience in the basic management of cardiac arrest. It is hoped that the “Sequence of Action” can be used as a template by individual national resuscitation organizations. This template should not, however, be considered a rigid standard. It is intended primarily to remove the many minor international differences in BLS education that have developed over the last 30 years, often without any basis in science. For example, if the current BLS guidelines of the ERC and the AHA are compared, most of the differences exist without any particular rationale and are based simply on quirks of historical practice. It is hoped that by removing these, BLS training can become as uniform as possible throughout the world. The process for the development of the advisory statements involved 1. Identification of major and minor differences between existing BLS guidelines.2 3 Minor differences mostly involved the use of words rather than any real differences of opinion about scientific content. They were resolved by arriving at a consensus. 2. Presentation of formal position papers on areas of major difference with an emphasis on available scientific evidence. The group attempted to reach consensus on items of controversy, but sometimes the …

Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Introduction Since 2000, the International Liaison Committee on Resuscitation (ILCOR) has published the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) every 5 years based on review of cardiopulmonary resuscitation (CPR) science. Seven task forces with representatives from the 7 member resuscitation organizations create the CoSTR that enables regional resuscitation organizations to create their individual guidelines. The different guidelines are based on the scientific evidence and incorporate or adjust for regional considerations.

Single rescuer adult basic life support

This document presents the consensus view of the Basic Life Support (BLS) Working Group of the International Liaison Committee on Resuscitation (ILCOR), which represents the world’s major resuscitation organizations (including the American Heart Association [AHA], the Australian Resuscitation Council, the European Resuscitation Council [ERC], the Heart and Stroke Foundation of Canada, and the Resuscitation Councils of Southern Africa). These advisory statements have evolved during 10 meetings of ILCOR from 1991 to the present. The scientific basis for the treatment of cardiac arrest has an active international literature.1 The purpose of creating these advisory statements is to take full advantage of international perspective and experience in the basic management of cardiac arrest. It is hoped that the “Sequence of Action” can be used as a template by individual national resuscitation organizations. This template should not, however, be considered a rigid standard. It is intended primarily to remove the many minor international differences in BLS education that have developed over the last 30 years, often without any basis in science. For example, if the current BLS guidelines of the ERC and the AHA are compared, most of the differences exist without any particular rationale and are based simply on quirks of historical practice. It is hoped that by removing these, BLS training can become as uniform as possible throughout the world. The process for the development of the advisory statements involved 1. Identification of major and minor differences between existing BLS guidelines.2 3 Minor differences mostly involved the use of words rather than any real differences of opinion about scientific content. They were resolved by arriving at a consensus. 2. Presentation of formal position papers on areas of major difference with an emphasis on available scientific evidence. The group attempted to reach consensus on items of controversy, but sometimes the …

Part 3: Evidence Evaluation Process

Peter T. Morley, Chair; Dianne L. Atkins; John E. Billi; Leo Bossaert; Clifton W. Callaway; Allan R. de Caen; Charles D. Deakin; Brian Eigel; Mary Fran Hazinski; Robert W. Hickey; Ian Jacobs; Monica E. Kleinman; Rudolph W. Koster; Mary E. Mancini; William H. Montgomery; Laurie J. Morrison; Vinay M. Nadkarni; Jerry P. Nolan; Robert E. O’Connor; Jeffrey M. Perlman; Michael R. Sayre; Tanya I. Semenko; Michael Shuster; Jasmeet Soar; Jonathan Wyllie; David Zideman

Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

To preserve the public trust and integrity of the International Liaison Committee on Resuscitation (ILCOR) evidence evaluation process, in 2004 ILCOR established a conflict of interest (COI) policy1,E1 to manage any real or potential conflicts of interest in an open and effective manner. Readers of the electronic version of this supplement can access the online documents by clicking on the E# callout, which will take them to the hyperlink in the Online Documents Cited list at the end of this editorial. Readers of the print version can access the documents at the URLs listed or by clicking the links found at http://www.C2005.org. This editorial explains the ILCOR and American Heart Association (AHA) COI policies and their application throughout the 2005 evidence evaluation process. ILCOR and the AHA also welcome readers’ questions and feedback on this process. The value of the ILCOR evidence evaluation process depends on rigorous expert review of published science. Therefore, it is essential that any potential professional conflict of interest be fully disclosed and managed effectively during the planning and conduct of the evidence evaluation process, especially when issues arise. Because many of the world’s most qualified scientific experts may have professional relationships that could pose a real or perceived conflict of interest, it is not always possible to avoid all involvement by such persons. It is necessary, however, to limit and manage their involvement in areas of potential conflict, especially to minimize their influence over consensus statements or recommendations in such areas. ILCOR COI procedures applied to all ILCOR delegates, 2005 Consensus Conference participants, observers, worksheet experts, worksheet authors, editors of the ILCOR 2005 CPR Consensus document (published in this supplement), and all others working on ILCOR projects. As host of the 2005 Consensus Conference, the AHA also required every participant to complete an AHA …

Part 2: Evidence Evaluation and Management of Potential or Perceived Conflicts of Interest 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In summary, the evidence review process has attempted to provide a systematic review of the scientific literature using a priori defined methods. The details and steps of the literature review are transparent and replicable. External opinions and community critique are highly valued, and the final products represent the combined labor of hundreds of participants.

Part 2: Evidence Evaluation and Management of Conflicts of Interest: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The process for evaluating the resuscitation science has evolved considerably over the past 2 decades. The current process, which incorporates the use of the GRADE methodology, culminated in the 2015 CoSTR publication, which in turn will inform the international resuscitation councils’ guideline development processes. Over the next few years, the process will continue to evolve as ILCOR moves toward a more continuous evaluation of the resuscitation science.

Part 2: International collaboration in resuscitation science: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

With the founding of the International Liaison Committee on Resuscitation (ILCOR) in 1992, an international collaboration of clinicians and researchers was convened to identify, evaluate, and interpret the most valid resuscitation science. This supplement to Circulation (simultaneously published in Resuscitation) presents the results of ILCOR’s most recent and extensive efforts to reach consensus on interpretation of resuscitation science and treatment recommendations. ILCOR continues to strive to reach a common goal of universal resuscitation guidelines. Building on the 2005 International Consensus on CPR and ECC Science With Treatment Recommendations,1,2 the 2010 International Consensus Conference held in Dallas, Texas, in February 2010 involved 313 experts from 30 countries. During the 2 years leading up to this conference, over 350 worksheet authors reviewed several thousand relevant, peer-reviewed publications to address more than 400 specific resuscitation questions, each in standard PICO (Population, Intervention, Comparison, Outcome) format. The experts reviewed, summarized, and categorized several thousand relevant, peerreviewed publications into level of evidence grids, proposed consensus on science statements, and where possible, provided evidence-based treatment recommendations.3 Key knowledge gaps were also identified and documented, with the purpose of stimulating further research in those areas. Ultimately scientific consensus was achieved by continuous discussion and debate in multiple face-to-face meetings and webinars, and finally through focused discussions of the evidence evaluation worksheets during the 3 days of the International Consensus Conference. Particular attention was paid to recognizing applicable advances in resuscitation science, while managing potential conflicts of interest among participants and identifying topics that lacked good evidence to support or change current practice. The year 2010 marks the 50th Anniversary of cardiopulmonary resuscitation (CPR). The original reports of rescue breathing,4 closed-chest compressions,5 and the effective combination of the two6 created an immediate demand for CPR training and resuscitation guidelines. In 1966, the Institute of Medicine (in the United States) convened the first conference to specifically review available evidence and to recommend standards for CPR and emergency cardiovascular care (ECC) techniques.7 The American Heart Association (AHA) sponsored subsequent conferences in 1973 and 1979.8,9 Parallel efforts occurred internationally as other resuscitation organizations faced a growing demand for CPR training.10 Inevitably variations in resuscitation techniques and training methods began to emerge from countries and regions of the world. Increasing awareness of these variations in resuscitation practices sparked interest in gathering international experts at a single location with the aim of achieving consensus in resuscitation techniques. The AHA convened such a meeting in 1985, inviting resuscitation leaders from many countries to observe the process by which the AHA reviewed evidence to create guidelines for CPR and ECC.11 Observation by these international guests, many of whom were passionately devoted to improving resuscitation outcomes in their own countries, soon led to the realization that much could be learned from international collaboration. By 1992, when the AHA convened their next Guidelines Conference, more than 40% of the participants were from outside the United States.12 During this 1992 conference, a panel on international cooperation on CPR and ECC endorsed the need to foster a multinational base of evidence for resuscitation practices. What was lacking was a focused and structured mechanism with which to capture and assess this growing body of published evidence. That panel strongly recommended that an expanded group of international experts initiate a systematic review of the world’s resuscitation