Top Things to Know: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR)

Published: November 11, 2021

  1. New communications technologies offer promising new options for emergency medical dispatch to assist lay-rescuer CPR in OHCA settings. Very little research has been done in this area but does show promise. Future more extensive clinical trials are needed to determine efficacy.
  2. Head-up CPR is a highly debated resuscitation strategy that is gaining more interest in the provider community that may potentially improve cerebral perfusion. However, very little evidence was found to support the routine practice and the International Liaison Committee on Resuscitation (ILCOR) BLS task force suggests against the routine use of head-up CPR until further clinical trials can determine the efficacy.
  3. The need for emergent post arrest Coronary Angiography (CAG) is known for ST-segment MI arrests, but the ALS task force further reviewed the science for no ST-segment elevation and any initial rhythm, no ST-segment elevation and initial shockable rhythm, and ST-segment elevation. It was concluded that for comatose post arrest patients without ST-segment elevation either early or delayed approach for CAG is reasonable, while early CAG is reasonable for post arrest patients with ST-segment elevation.
  4. With the increase of patients being placed in the prone position due to COVID-19 treatments the ALS task force made the good practice statement that if an advanced airway was in place and immediate supination is not feasible, prone CPR could be initiated until the patient could be supinated. However, there is a strong recommendation if no advanced airway in place that the patient should be supinated prior to initiating resuscitation.
  5. Clamping the umbilical cord at birth has a significant impact on a newborn’s cardiovascular system. A systematic review with extensive subgroup analysis yielded recommendations for delaying cord clamping in several newborn populations. Insufficient evidence was found to make recommendations for infants who require resuscitation.
  6. With the increase in the availability of digital learning option the EIT task force reviewed self-directed, digitally based resuscitation education programs that were geared towards teaching BLS to the lay public and found that instructor led training with hands on manikin practice still remains optimal, but when not feasible video-based training could be used.
  7. Thermal burns are a common first aid emergency and the ILCOR FA task force reviewed the literature to update their recommendations. Active cooling with running water is recommended for both adults and children who suffer from a thermal burn, but special care needs to be taken to ensure the pediatric patient does not suffer from excessive cooling in the process. No specific duration of cooling could be recommended at this time without further studies.
  8. Exertional dehydration is another common global first aid emergency. The first aid task force reviewed many different forms of oral rehydration and found that water or any form of rehydration drink is beneficial. Commercially prepared rehydration drinks can provide some benefit along with alternatives such as coconut water or milk.
  9. Pediatric bleeding in the first aid setting can be life threatening. The First Aid task force found that the use of a manufactured windlass tourniquet could be used in children to control life threatening extremity bleeding, but must be avoided in infants and children with extremities that are too small for the device. In these cases, manual pressure and hemostatic dressings are recommended.
  10. In light of the COVID-19 global pandemic ILCOR convened a special international working group to address COVID-19 transmission during cardiopulmonary resuscitation. Several questions were reviewed and resulted in recommendations. While the science is still being generated the working group acknowledged that CPR has the protentional to generate aerosols and that health care professional should use PPE during resuscitation procedures, however, in some special circumstances defibrillation could be delivered prior to donning PPE. It is suggested that lay rescuers should continue to perform hands-only CPR and, for those trained and comfortable, respirations should be given to pediatric patients.