Top Things to Know: 2020 International Consensus on CPR and ECC Science With Treatment Recommendations
- Sudden cardiac arrest remains a leading cause of death worldwide. For example, just in the U.S., more than 350,000 EMS-assessed cardiac arrests and 209,000 in-hospital cardiac arrests occur annually. Despite advances in resuscitation science, U.S. survival rates following out-of-hospital cardiac arrest average 10% and, following in-hospital cardiac arrest, average 27% for adults and about 40% for infants and children. Although survival from in-hospital and out-of-hospital cardiac arrest has increased over the past decade, there is still tremendous potential for improvement.
- The mission of ILCOR is to promote, disseminate, and advocate international implementation of evidence-informed resuscitation and first aid by using transparent evaluation and consensus summary of scientific data. The goal of this 2020 ILCOR CoSTR Summary is to provide the current analysis of published resuscitation evidence to aid member councils such as the AHA in the development of evidence-based resuscitation and first aid guidelines and training materials.
- For this 2020 CoSTR, three types of evidence evaluations are included:
- Systematic reviews: structured evidence searches with rigorous analysis of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Based on ILCOR consensus, only these reviews could lead to new or modified treatment recommendations.
- Scoping reviews: structured evidence searches resulting in a summary of available evidence, with no GRADE analysis. These searches resulted in a recommendation for or against consideration of a future systematic review, based on the quantity and types of evidence identified.
- Evidence updates: These reviews repeated previous search strategies when available and resulted in a brief summary of available evidence without GRADE analysis. These reviews resulted in a recommendation for or against consideration of a future systematic review.
- The “hottest” topics included in the 2020 CoSTR BLS Update address: CPR during transport, a “phone first” compared with a “CPR first” sequence for initiating adult CPR in the out-of-hospital setting, immediate CPR with or without naloxone therapy for suspected opioid-associated emergencies, use of feedback devices to evaluate and improve CPR quality and analysis of cardiac rhythm during chest compressions. The BLS task force also analyzed evidence from systematic reviews regarding dispatcher identification of cardiac arrest, the importance of a firm surface for CPR, the optimal initial sequence of CPR, optimal hand position during chest compressions, timing of rhythm checks, alternative techniques, CPR before defibrillation, methods to remove foreign body airway obstruction, and factors predicting outcome of BLS resuscitation after drowning, as well as evidence from 3 scoping reviews and 1 evidence update.
- The “hottest” topics included in the 2020 ALS CoSTR address: optimal vasopressors during cardiac arrest, focusing on recent evidence regarding use of epinephrine for out-of-hospital cardiac arrest, targeted temperature management; double sequential defibrillation; intravenous versus intraosseous route of drug delivery during CPR and use of point-of-care echocardiography for prognostication during CPR. In addition to analyzing evidence from a systematic review regarding treatment of cardiac arrest associated with pulmonary embolism, the ALS task force analyzed evidence from several systematic reviews regarding treatment following return of spontaneous circulation (ROSC), including oxygen dose, ventilation strategies, use of prophylactic antibiotics, seizure prophylaxis and multiple tools and approaches for prognostication. The ALS Task Force also analyzed evidence from 2 scoping reviews and 15 evidence updates.
- The “hottest” topics included in the 2020 PLS CoSTR address: fluid administration rate for septic shock, initial epinephrine dose and dose intervals during resuscitation, ventilation rate with an advanced airway during CPR, and use of hemodynamic monitoring during resuscitation. The PLS Task Force also analyzed evidence from systematic reviews on the topics of the sequence of compression and ventilation, intravenous versus intraosseous drug delivery routes and oxygen and carbon dioxide targets following ROSC, as well as evidence from 10 scoping reviews and 37 evidence updates.
- The “hottest” topics included in the 2020 NLS CoSTR address: tracheal intubation and suctioning of nonvigorous newborns with meconium staining, use of epinephrine for neonatal resuscitation, initial oxygen concentration for preterm infants and the impact of resuscitation duration on outcome. The NLS Task Force also analyzed evidence from systematic reviews on the topics of sustained inflation for initial breaths and intraosseous compared with intravenous (umbilical vein) routes of emergency fluid and drug administration, as well as evidence from 3 scoping reviews and 12 evidence updates.
- The “hottest” topics included in the 2020 EIT CoSTR address: impact of Emergency Medical Services provider experience and exposure to resuscitation, community initiatives promoting bystander CPR, first aid education regarding opioid overdose, and bystander willingness to perform CPR and out of hospital CPR training in low-resource settings. The EIT Task Force also analyzed evidence from systematic reviews on the topics of impact of ALS team-member training on resuscitation outcome, spaced learning (i.e., learning at intervals), and decision rules for termination of resuscitation for out-of-hospital and in-hospital cardiac arrest. In addition, the EIT Task Force evaluated evidence from 7 evidence updates.
- The “hottest” topics included in the 2020 First Aid CoSTR address: control of life-threatening external bleeding, cooling of heatstroke and exertional hyperthermia, stroke recognition, and care of an avulsed tooth. The First Aid Task Force also analyzed evidence from systematic reviews on the topics of methods of glucose administration, use of supplementary oxygen for suspected stroke, administration of aspirin for chest pain and compression wrap for closed extremity joint injury, as well as evidence from 8 scoping reviews and 2 evidence updates.
- The ILCOR task forces will continue to prioritize questions and topics and analyze published studies to develop future evidence-based treatment recommendations.
Citation
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang T-Z, Hazinski MF. Executive summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S2–S27. doi: 10.1161/CIR.0000000000000890
Morley PT, Atkins DL, Finn JC, Maconochie I, Nolan JP, Rabi Y, Singletary EM, Wang T-L, Welsford M, Olasveengen TM, Aickin R, Billi JE, Greif R, Lang E, Mancini ME, Montgomery WH, Neumar RW, Perkins GD, Soar J, Wyckoff MH, Morrison LJ. Evidence evaluation process and management of potential conflicts of interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S28–S40. doi: 10.1161/CIR.0000000000000891
Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KKC, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT; on behalf of the Adult Basic Life Support Collaborators. Adult basic life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S41–S91. doi: 10.1161/CIR.0000000000000892
Berg KM, Soar J, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D’Arrigo S, Deakin CD, Donnino MW, Drennan IR, Granfeldt A, Hoedemaekers CWE, Holmberg MJ, Hsu CH, Kamps M, Musiol S, Nation K, Neumar RW, Nicholson T, O’Neil BJ, Otto Q, Paiva EF, Parr MJA, Reynolds JC, Sandroni C, Scholefield BR, Skrifvars MB, Wang T-L, Wetsch WA, Yeung J, Morley PT, Morrison LJ, Welsford M, Hazinski MF, Nolan JP; on behalf of the Adult Advanced Life Support Collaborators. Adult advanced life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S92–S139. doi: 10.1161/CIR.0000000000000893
Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian A-M, Nadkarni VM, Ng K-C, Nuthall GA, Ong GYK, Reis AG, Schexnayder SM, Scholefield BR, Tijssen JA, Nolan JP, Morley PT, Van de Voorde P, Zaritsky AL, de Caen AR; on behalf of the Pediatric Life Support Collaborators. Pediatric life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S140–S184. doi: 10.1161/CIR.0000000000000894
Wyckoff MH, Wyllie J, Aziz K, de Almeida MF, Fabres J, Fawke J, Guinsburg R, Hosono S, Isayama T, Kapadia VS, Kim H-S, Liley HG, McKinlay CJD, Mildenhall L, Perlman JM, Rabi Y, Roehr CC, Schmölzer GM, Szyld E, Trevisanuto D, Velaphi S, Weiner GM; on behalf of the Neonatal Life Support Collaborators. Neonatal life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S185–S221. doi: 10.1161/CIR.0000000000000895
Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh M-J, Iwami T, Lauridsen KG, Lockey AS, Ma MH-M, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC; on behalf of the Education, Implementation, and Teams Collaborators. Education, implementation, and teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S222–S283. doi: 10.1161/CIR.0000000000000896
Singletary EM, Zideman DA, Bendall JC, Berry DC, Borra V, Carlson JN, Cassan P, Chang W-T, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin AM, Sakamoto T, Swain JM, Woodin JA; on behalf of the First Aid Science Collaborators. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020;142(suppl 1):S284–S334. doi: 10.1161/CIR.0000000000000897