Clifton Callaway

7/30/2019 Clifton Callaway

1/45

Guidelines:ILCOR

Resuscitation

Guidelines

CliftonW.Callaway,MD,PhD

UniversityofPittsburgh

Pittsburgh,PA,USA


2/45

InternationalLiaisonCommitteeon

Resuscitation(ILCOR)

AmericanHeartAssociation(AHA)

EuropeanResuscitation

Council

(ERC)

HeartandStrokeFoundationofCanada(HSFC)

AustralianandNewZealandCommitteeon

Resuscitation(ANZCOR)

ResuscitationCouncilsofSouthernAfrica(RCSA)

Inter

American

Heart

Foundation

(IAHF) ResuscitationCouncilofAsia(RCA)


3/45


4/45

Consensuson

Science

Process


5/45

CoSTRProcess

ILCORTaskForces GenerateQuestions

RefineQuestions

RecruitWorksheet

Authors

AssignQuestionstoAuthors

WorksheetAuthors SearchLiterature

RateLevels

of

Evidence

(LOE)

PreliminaryRecommendations

ILCORTaskForces Finalizeworksheets

Synthesizeinto

Consensus

on

Science

and

TreatmentRecommendations(CoSTR)

IndividualResuscitationCouncils RegionalGuidelinesbasedonCoSTR


6/45

CoSTRProcess


RefineQuestions

RecruitWorksheet

Authors



RateLevels

of

Evidence

(LOE)



Synthesizeinto

Consensus

on

Science

and



BasicLifeSupport(BLS)

AdvanceLifeSupport

(ALS)

PediatricLifeSupport

(PED)

NeonatalLife

Support

AcuteCoronary

Syndrome(ACS)

Education,

Implementationand

Teams(EIT)


7/45

Whois

on

aTask

Force?

Volunteers

Selectedby

each

council

Expertsinfield

Willing

to

represent

the

council

in

ILCOR Committedtoparticipationinwholeprocess


8/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet

Authors



RateLevels

of

Evidence

(LOE)



Synthesizeinto

Consensus

on

Science

and



Reviewedresearch

Gaps identified

duringprevious

Guidelinesprocess

EvidenceMapping

fromfromprevious

guidelines

Discussionofissues

raisedbyeachcouncil

Generatealistoftopics


9/45

GenerateList

of

Questions

DiscussionofNew

Literature

QuestionsaboutPrior

Guidelines

ListofTopicsand

Questions

Gapsidentified

in

prior

cycleofevidencereview

KnowledgeMapping


10/45

Questionsin

PICO Format

Population/Patient Adultpatientswithoutofhospitalcardiacarrest

Intervention Vasopressin

Comparison

Epinephrine Outcome

Survivaltohospitaldischarge

Inadult

patients

with

out

of

hospital

cardiac

arrest,

doestheuseofvasopressincomparedtoepinephrineincreasesurvivaltohospitaldischarge?


11/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet

Authors



RateLevels

of

Evidence

(LOE)



Synthesizeinto

Consensus

on

Science

and



Expertsinthefield

Recommendedby

TaskForce

Callforreferrals

fromSpecialty

Organizations

VolunteerstoWebsite

Task

Force

reviewed

CV

andqualifications

ConflictsofInterest!


12/45

Conflictsof

Interest

(COI)

TwoCOICoChairsassignedtooverseeCOIprocess

Everyparticipant

completed

an

AHA

COI

form

AHAStaffmadecertainallparticipantshadcompletedformspriortoanymeetingsorassignments

802COIFormscollectedandreviewed

TaskForce

co

chairs

were

required

to

be

free

of

major

COI

in

thetopicareaoftheTaskForce

TaskForcecochairsreviewedallCOIforms

Reassignedtopics

to

new

authors

when

there

was

any

perceivedCOI

WorksheetshadanadditionalspacetodiscloseCOI

No

Worksheet

could

be

accepted

without

COI

disclosure


13/45

Managementof

COI

yCOIinformationpostedwithworksheetson

website

y Industryemployeesexcluded

yNo

industry

support

accepted

for

C2005

or

C2010

yCOIprintedinC2010programandfinalGuidelines

publication

yCOIquestionnairescompletedbyallparticipants

(802collectedandreviewed)


14/45

ManagementofCOI

COIforeachspeakerprojectedduringmeetings


15/45


16/45


17/45


18/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet

Authors



Rate

Levels

of

Evidence

(LOE)



Synthesizeinto

Consensus

on

Science

and



Worksheets!


19/45

Worksheet

StatementofQuestion

Assignedto

Worksheet

Author

LiteratureSearchStrategyandResults

Author

generates

Worksheetexpertreviewsandapproves

SummaryofEvidenceTable

UseILCOR

Levels

of

Evidence 1

5

CommentsandSummaryofEvidence


20/45


21/45

Reproducibleand

Comprehensive

Search


22/45


23/45

Levelsof

Evidence

(LOE)

Directlyaddressesquestion?

Hasitsowncontrolgroup?

Usesconcurrentcontrols?

Usestrue

randomization?

LOE5

LOE4

LOE3

LOE2

LOE1

No

Yes

Yes

Yes

Yes

No

No

No


24/45


25/45


26/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet

Authors AssignQuestionstoAuthors


Rate

Levels

of

Evidence

(LOE)



Synthesizeinto

Consensus

on

Science

and



Meetings

Webinarsand

ConferenceCalls

2010

Consensus

Conference


27/45

ILCORTask

Force

Meetings

2TFChairsMembersandWorksheet

AuthorsfromeachCouncil


28/45

EvidenceEvaluationProcess

411scientificevidencereviews

on277topics

PostedonInternetforPublic

Comment

Presentedeachoneinaseriesofin

personmeetings,

webinars

or

teleconferences

Writinggroupmembersvotedon

eachrecommendation

ParticipantswithanyCOIabstained

WordsmithTreatment

Recommendationsatthistime


29/45

2010ConsensusConference

(February2010)

313participantsat2010ConsensusConference

Invitedexperts,stakeholdersandsociety

representatives

FinalizedConsensusonScienceandTreatment

Recommendations


30/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet



RateLevels

of

Evidence

(LOE)



Synthesize

into

Consensus

on

Science

and



PublishinResuscitation

andCirculation

AfterPeer

Review

November2010


31/45

CoSTRProcess


RefineQuestions

Recruit

Worksheet



RateLevels

of

Evidence

(LOE)



Synthesize

into

Consensus

on

Science

and



Guidelinesin

October

2010

Educationalproducts

andcourses(ACLS,

PALSappear

Mid

2011)


32/45

IndividualCouncils

Write

Guidelines

Specificrecommendationsvarybetween

regionsbecause

of

Localdrugordeviceavailability

Differentinterpretationofdata

DecisionsabouttopicswithInsufficient

evidencetorecommendfororagainst


33/45

Whatwill

we

change

for

2015?

StreamlineLiteratureSearch

2010:Worksheet

Author

performs

search

2015:Professionallibrarians

ReplaceLevelsofEvidencesystem

2010:ILCORGrades15

2015:

GRADE

System


34/45

Search Select

Articles

Rate

Features

of

Articles

WriteProse

Summary

Build

Tables

WriteCoSTR

Worksheet

Authors TaskForce

TaskForce

/Experts2010


35/45

Search Select

Articles

Rate

Features

of

Articles

WriteProse

Summary

Build

Tables

WriteCoSTR

Librarian(s) WorksheetAuthors TaskForce

Worksheet

Authors TaskForce

TaskForce

/Experts2010

2015


36/45

GradingofRecommendations

Assessment,Development

and

Evaluation(GRADE)


37/45

TheGRADE

system

classifies

evidence

into

one

offourqualitygrades

GRADE DEFINITIONHigh Further research is very unlikely to change ourconfidence in the estimate of effect.Moderate{

Further research is likely to have an important impact onour confidence in the estimate of effect and may changethe estimate.Low{{

Further research is very likely to have an importantimpact on our confidence in the estimate of effect and islikely to change the estimate.Very Low{{{

Any estimate of effect is very uncertain.


38/45

GRADEapproachtostudiesandtrials

Randomizedcontrolled

trials

without

importantlimitationsprovideHIGH qualityevidence

Observationalstudieswithoutspecial

strengths

provide

LOW quality

evidence


39/45

GRADE

Evidence

Evaluation

Limitationsorspecialstrengthscanmodifythequalityoftheevidenceofboth

randomized

trials

and

observational

studies. Upgradealevel

Downgradealevel


40/45

Levels

of

Evidence

in

GRADE

Randomized

Controlled

Trial

Observational

Study

HighSpecialStrengths

WeaknessesLow

High

Moderate

Low

VeryLow

{{

{{{

{

EvaluationofStudy

{{


41/45

AlgorithmstoEvaluateEvidence

Table 5.GRADE profile for assessing quality of evidence for the randomized controlled trials


42/45

Table 5.GRADE profile for assessing quality of evidence for the randomized controlled trials

Quality assessment

No. of

studiesDesign Limitations Inconsistency Indirectness Imprecision

Other

considerations

Mortality (follow-up 6 months)

2Randomised

trialsSerious1

No serious

inconsistencySerious2 Serious3 None

Neurological outcome (follow-up 6 months)

1Randomised

trialsSerious4

No serious

inconsistencySerious5 Serious6 None

Summary of findings

ImportanceNo. of patients Effect

QualityTherapeutic

hypothermiaControl

Relative

(95%CI)Absolute

17/22

(77.3%)

20/22

(90.9%)

RR 0.85

(0.65 to1.12)

136 fewer

per 1000

(from 318fewer to

109 more)

VERY

LOW

CRITICAL

14/16

(87.5%)

17/17

(100%)

RR 0.88

(0.71 to

1.08)

120 fewer

per 1000

(from 290

fewer to

80 more)

VERY

LOW

CRITICAL


43/45

Conclusion SystematicProcess

Involveslarge

number

of

stakeholders

ProactivelymanagesConflictsofInterest

Emphasizestransparency

PersonnelIntensive

Worksheetauthorsspecificallydisadvantaged

becausetheymustlearnprocessononeortwo

worksheets Staffandtaskforcesmustmonitormanymoving

parts


44/45

Conclusion Thisprocessiscoupledwithastrong

knowledgedissemination

machine

AHATrained~55MillionpeopleinCPRandFirst

Aid

ACLSis

taught

to

12million

providers

in

the

UnitedStates


45/45

Questions?

Date post:	14-Apr-2018
Category:	Documents
Upload:	gita-chan
View:	225 times
Download:	0 times

Clifton Callaway

Documents