Cardiac Arrest Outcomes Research Articles

Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group Ryan KM, Bui MD, Dugas JN, et al. Resuscitation, Volume 163, 2021, Pages 130-135, ISSN 0300-9572, https://doi.org/10.1016/j.resuscitation.2020.12.027.

Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group Ryan KM, Bui MD, Dugas JN, et al. Resuscitation, Volume 163, 2021, Pages 130-135, ISSN 0300-9572, https://doi.org/10.1016/j.resuscitation.2020.12.027.

Trends, Prevalence, and Outcomes of Sudden Cardiac Arrest Post Cardiac Transplant: A Nationwide 16-Year Study.

Heart transplantation is the most effective long-term therapy for end-stage heart disease. There is limited data related to sudden cardiac arrest (SCA) in postheart transplant recipients. We aimed to describe the trends, and rate of SCA following heart transplantation and thereby identify clinical predictors as well as outcomes of SCA in patients post-transplant. We queried the National Inpatient Sample (NIS) with administrative codes for SCA and heart transplant. We assessed baseline differences between SCA and non-SCA admissions, with hazard ratios adjusted for age, gender, CCI, and race. Multivariable logistic regression models were generated to identify the independent predictors for SCA. There was a total of 30,020 hospitalizations of heart transplant recipients between 1999 and 2014 in the United States and among these 1,953 patients (6.5%) suffered SCA with an increasing trend of admissions for SCA. Among the patients who suffered from SCA, 18.83% died during the same hospitalization, 19.29% were discharged to a long-term facility, and 61.38% were discharged home. Multivariate analysis demonstrated that conduction system disorders (Hazard ratio [95% confidence interval]; 7.1 [4.5-11.1]), female gender (HR:1.2 [1.1-1.3]), diabetes (HR:1.4 [1.2-1.6]), and hypertension (HR:1.2 [1.1-1.4]) were the strongest predictors for SCA. SCA hospitalizations occur in 6.5% of patients post cardiac transplant and have been increasing from 1999 to 2014. Conduction block, graft rejection, female gender, hypertension, diabetes are independent predictors for SCA in heart transplant recipients.

Predictors and outcome of cardiac arrest in paediatric patients presenting to emergency medicine department of tertiary hospitals in Tanzania

BackgroundThe survival of children who suffer cardiac arrest is poor. This study aimed to determine the predictors and outcome of cardiac arrest in paediatric patients presenting to an emergency department of a tertiary hospital in Tanzania.MethodologyThis was a prospective cohort study of paediatric patients > 1 month to ≤ 14 years presenting to Emergency Medicine Department of Muhimbili National Hospital (EMD) in Tanzania from September 2019 to January 2020 and triaged as Emergency and Priority. We enrolled consecutive patients during study periods where patients’ demographic and clinical presentation, emergency interventions and outcome were recorded. Logistic regression analysis was performed to identify the predictors of cardiac arrest.ResultsWe enrolled 481 patients, 294 (61.1%) were males, and the median age was 2 years [IQR 1–5 years]. Among studied patients, 38 (7.9%) developed cardiac arrest in the EMD, of whom 84.2% were ≤ 5 years. Referred patients were over-represented among those who had an arrest (84.2%). The majority 33 (86.8%) of those who developed cardiac arrest died. Compromised circulation on primary survey (OR 5.9 (95% CI 2.1–16.6)), bradycardia for age on arrival (OR 20.0 (CI 1.6–249.3)), hyperkalemia (OR 8.2 (95% CI 1.4–47.7)), elevated lactate levels > 2 mmol/L (OR 5.2 (95% CI 1.4–19.7)), oxygen therapy requirement (OR 5.9 (95% CI 1.3–26.1)) and intubation within the EMD (OR 4.8 (95% CI 1.3–17.6)) were independent predictors of cardiac arrest.ConclusionThirty-eight children developed cardiac arrest in the EMD, with a very high mortality. Those who arrested were more likely to present with signs of hypoxia, shock and acidosis, which suggest they were at later stage in their illness. Outcomes can be improved by strengthening the pre-referral care and providing timely critical management to prevent cardiac arrest.

Sudden cardiac arrest in commercial airports: Incidence, responses, and implications

Billions of travelers pass through airports around the world every year. Airports are a relatively common location for sudden cardiac arrest when compared with other public venues. An increased incidence of cardiac arrest in airports may be due to the large volume of movement, the stress of travel, or adverse effects related to the physiological environment of airplanes. Having said that, airports are associated with extremely high rates of witnessed arrests, bystander interventions (eg. CPR and AED use), shockable arrest rhythms, and survival to hospital discharge. Large numbers of people, a high density of public-access AEDs, and on-site emergency medical services (EMS) resources are probably the major reasons why cardiac arrest outcomes are so favorable at airports. The success of the chain of survival found at airports may imply that applying similar practices to other public venues will translate to improvements in cardiac arrest survival. Airports might, therefore, be one model of cardiac arrest preparedness that other public areas should emulate.

Utilizing community level factors to improve prediction of out of hospital cardiac arrest outcome using machine learning

ObjectivesTo evaluate the impact of community level information on the predictability of out-of-hospital cardiac arrest (OHCA) survival. MethodsWe used the Cardiac Arrest Registry to Enhance Survival (CARES) to geocode 9,595 Chicago incidents from 2014 to 2019 into community areas. Community variables including crime, healthcare, and economic factors from public data were merged with CARES. The merged data were used to develop ML models for OHCA survival. Models were evaluated using Area Under the Receiver Operating Characteristic curve (AUROC) and features were analyzed using SHapley Additive exPansion (SHAP) values. ResultsBaseline results using CARES data achieved an AUROC of 84%. The final model utilizing community variables increased the AUROC to 88%. A SHAP analysis between high and low performing community area clusters showed the high performing cluster is positively impacted by good health related features and good community safety features positively impact the low performing cluster. ConclusionUtilizing community variables helps predict neurologic outcomes with better performance than only CARES data. Future studies will use this model to perform simulations to identify interventions to improve OHCA survival.

Pediatric Cardiac Arrest Outcomes in the United States: A Nationwide Database Cohort Study.

BackgroundKnowledge about the causes and outcomes of pediatric cardiac arrest in the emergency department is limited. The aim of our study was to evaluate the characteristics and outcomes of pediatric cardiac arrest in the emergency department (EDCA) and inpatient (IPCA) settings in the United States using a large database designed to provide nationwide estimates.MethodsWe performed a retrospective cohort study using the Nationwide Emergency Department Sample (NEDS), a database that includes both ED and inpatient encounters. The NEDS was analyzed for episodes of cardiac arrest between 2016-2018 in patients aged ≤18 years. Patients with cardiac arrest were identified using the International Classification of Diseases, 10th revision codes.ResultsA total of 15,348 pediatric cardiac arrest events with cardiopulmonary resuscitation were recorded, of which 13,239 had EDCA and 2,109 had IPCA. A lower survival rate of 19% was observed for EDCA compared to 40.4% for IPCA. While more than half of the EDCA events had no associated diagnoses, trauma (15.6%), respiratory failure (5%), asphyxiation (2.7%), acidosis (2.4%), and ventricular arrhythmia (1.4%) were associated with the remaining events. In comparison, the most frequently associated diagnoses for IPCA were respiratory failure (75.8%), acidosis (43.9%), acute kidney injury (27.2%), trauma (27.1%), and sepsis (22.5%). ConclusionsSurvival rates for EDCA were less than half of that for IPCA. The low survival rates along with the distinctive characteristics of EDCA events suggest the need for further research in this area to identify remediable factors and improve survival.

The role of passive leg raise during cardiopulmonary resuscitation in sudden cardiac arrest: a systematic review and meta-analysis

Objective Passive leg raise (PLR) is an experimental cardiopulmonary resuscitation (CPR) technique involving elevation of the lower limbs from the horizontal plane during CPR. This procedure is thought to improve clinical outcomes in cardiac arrest. By comparing the use of PLR to conventional CPR, we aimed to evaluate survival outcomes and secondary outcomes of neurologically intact survival and return of spontaneous circulation (ROSC). Methods In this systematic review, databases of PubMed, Embase, and Cochrane Library were searched for relevant studies from inception to May 1st, 2021. Studies were included if they reported the use of PLR during CPR. Random-effects meta-analysis was performed for the outcome of survival to 30 days. Results The search yielded 554 articles, of which six met the criteria for inclusion (three animal and three human studies). The most common implementation of PLR was elevation of the heels to a 20- to 45-degree angle at the hips. Two human studies reported higher survival at hospital admission for patients that underwent PLR, though the difference was not significant. Two human studies reported lower ROSC and neurologically intact survival, while two animal studies reported higher ROSC and neurologically intact survival. The pooled effect on survival to 30 days/survival to hospital discharge was not significant (P=0.68), although our analysis showed a trend favoring PLR-CPR. Conclusion Despite several animal studies showing benefit from PLR-CPR, there are no human data supporting its use in human cardiac arrest. Future research needs to ascertain the best positioning during CPR to optimize clinical outcomes. Keywords: Heart Arrest, Cardiopulmonary resuscitation, Resuscitation

A national effort to improve outcomes for in-hospital cardiac arrest in China: The BASeline Investigation of Cardiac Arrest (BASIC-IHCA)

BackgroundIn-hospital cardiac arrest (IHCA) is a common clinical event with poor outcomes. Former IHCA registries in China were local, inconsistent in data reporting, and lacked attention to the process of care. Therefore, we designed and implemented the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA), the first national IHCA registry in China. MethodsBASIC-IHCA is a prospective, multicenter, observational study with a nationwide surveillance network covering urban and rural hospitals from seven geographic regions of China. IHCA patients were enrolled continuously, and data were collected from medical records by investigators at participating hospitals. Key variables referring to the updated Utstein Template included patient information, event variables, process of care, and outcomes. Follow-up was conducted by telephone interview to obtain details on long-term survival and neurological status. ResultsThirty-two urban hospitals and eight rural hospitals from twenty-nine provinces in seven geographic regions of China participated in BASIC-IHCA. The starting time of enrollment ranged from July 1, 2019, to January 1, 2020. By December 31, 2020, 35,451 IHCAs were enrolled in all participating hospitals, of which 19,493 (55%) received CPR, with a predominance of males (65%) and a median age of 65 years. ConclusionBASIC-IHCA is the first national registry for IHCA in China. It will describe the epidemiology and outcomes of IHCA from a nationwide perspective, with a particular focus on details of the process of care for quality improvement. Meanwhile, it will help to facilitate the standardization of IHCA-related data reporting in China.

Prognostic significance of the blood urea nitrogen to creatinine ratio in in-hospital cardiac arrest after targeted temperature management.

Targeted temperature management (TTM) has been reported to improve outcomes in in-hospital cardiac arrest (IHCA) patients but little has been investigated into the relationship between prognoses and the blood urea nitrogen to creatinine ratio (BCR). A retrospective analysis of data from IHCA survivors treated with TTM between 2011 and 2018 was conducted based on the Research Patient Database Registry of the Partners HealthCare system in Boston. Serum laboratory data were measured during IHCA and within 24 hours after TTM completion. Intra-arrest and post-TTM BCRs were calculated, respectively. The primary outcome was neurologic status at discharge. The secondary outcome was in-hospital mortality. The study included 84 patients; 63 (75%) were discharged with a poor neurologic status and 40 (47.6%) died. Regarding poor neurological outcome at discharge, multivariate analysis revealed that post-TTM BCR was a significant predictor (adjusted OR, 1.081; 95% CI, 1.002-1.165; p = 0.043) and intra-arrest BCR was a marginal predictor (adjusted OR, 1.067; 95% CI, 1.000-1.138; p = 0.050). Post-TTM BCR had an acceptably predictive ability to discriminate neurological status at discharge, with an area under the receiver-operating characteristic curve of 0.644 (95% CI, 0.516-0.773) and a post-TTM BCR cutoff value of 16.7 had a sensitivity of 61.9% and a specificity of 70.0%. Post-TTM BCR was a significant predictor of the neurologic outcome at discharge among IHCA patients receiving TTM. IHCA patients with elevated intra-arrest BCR also had a borderline poor neurological prognosis at discharge.

Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care

BackgroundSurvival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours. ObjectiveTo evaluate the association between hospital availability of TCC and IHCA survival. MethodsWe identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday–Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday–Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays). Results14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92–1.15; survival to discharge OR 0.94 [0.83–1.07]) or outside of the ICU (acute survival OR 1.03 [0.91–1.17]; survival to discharge OR 0.99 [0.86–1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction). ConclusionsHospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.

Risk factors and outcomes of sudden cardiac arrest in pediatric heart transplant recipients

Sudden cardiac arrest (SCA) is a prevailing cause of mortality after pediatric heart transplant (HT) but remains understudied. We analyzed the incidence, outcomes, and risk factors for SCA at our center. Retrospective review of all pediatric HT patients at our center from January 1, 2009 to January 1, 2021. SCA was defined as an abrupt loss of cardiac function requiring cardiopulmonary resuscitation and/or mechanical circulatory support (MCS). Events that occurred in the setting of limited resuscitative wishes, or while on MCS were excluded. Patient characteristics and risk factors were analyzed. Fourteen of 254 (6%) experienced SCA at a median of 3 (1, 4) years post-HT. Seven (50%) events occurred out-of-hospital. Eleven (79%) died from their initial event, 2 (18%) after failure to separate from extracorporeal membrane (ECMO). In univariate analysis, black race, younger donor age, prior acute cellular rejection (ACR) episode, pacemaker and/or ICD in place, and pre-mortem diagnosis of allograft vasculopathy were associated with SCA (P=.003-0.02). In multivariable analysis, history of ACR, younger donor age, and black race retained significance. [OR=6.3, 95% CI: 1.6-25.4, P=.01], [OR=0.9, 95% CI: 0.8-1, P=.04], and [OR=7.3, 95% CI: 1.1-49.9, P=.04], respectively. SCA occurred in 3 patients with a functioning ICD or pacemaker, which failed to restore a perfusing rhythm. SCA occurs relatively early after pediatric HT and is usually fatal. Half of events happen at home. Those who received younger donors, have a history of ACR, or are of black race are at increased risk. ICDs/pacemakers may offer limited protection.

Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand

BackgroundThe impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand.MethodsThis multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January–September 2019) and during the outbreak (January–September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared.ResultsThe study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68–1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49–1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2–9.3] min vs 10 [6–14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak.ConclusionThere was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.

Reassessment of mitochondrial cyclophilin D as a target for improving cardiac arrest outcomes in the era of therapeutic hypothermia

Uncertainty exists regarding whether cyclophilin D (CypD), a mitochondrial matrix protein that plays a key role in ischemia-reperfusion injury, can be a pharmacological target for improving outcomes after cardiac arrest (CA), especially when therapeutic hypothermia is used. Using CypD knockout mice (CypD-/-), we investigated the effects of loss of CypD on short-term and medium-term outcomes after CA. CypD-/- mice or their wild-type (WT) littermates underwent either 5 minute CA followed by resuscitation with and/or without hypothermia at 33°C-34°C (targeted temperature reached within minutes after resuscitation), or a sham procedure. Brain and cardiac injury were assessed using echocardiography, neurological scores, MRI and biomarkers. Seven day survival was compared using Kaplan-Meier estimates. The rate of restoration of spontaneous circulation was significantly higher in CypD-/- mice (with shorter cardiac massage duration) than in WT mice (P < 0.05). Loss of CypD significantly attenuated CA-induced release of troponin and S100ß protein, and limited myocardial dysfunction at 150 minutes after CA. Loss of CypD combined with hypothermia led to the best neurological and MRI scores at 24 hours and highest survival rates at 7 days compared to other groups (P < 0.05). In animals successfully resuscitated, loss of CypD had no benefits on day 7 survival while hypothermia was highly protective. Pharmacological inhibition of CypD with cyclosporine A combined with hypothermia provided similar day 7 survival than loss of CypD combined with hypothermia. CypD is a viable target to improve success of cardiopulmonary resuscitation but its inhibition is unlikely to improve long-term outcomes, unless therapeutic hypothermia is associated.

Association of pulmonary hypertension with survival and neurologic outcomes in adults with in-hospital cardiac arrest

BackgroundPulmonary hypertension (PH) has been associated with poor survival in multiple cardiopulmonary conditions, however its association with outcomes in cardiac arrest remains unknown. We aimed to evaluate the association of PH with survival and neurologic outcomes in adults with in-hospital cardiac arrest (IHCA). MethodsThe study population included adults with IHCA undergoing resuscitation at an academic tertiary-care medical center from 2011 to 2019. Patients were classified based upon the presence versus absence of PH, defined as a pulmonary artery systolic pressure >35 mmHg on pre-arrest echocardiogram. Survival to discharge and favorable neurological outcome (defined as a Glasgow Outcome Score of 4–5) served as the primary and secondary outcomes of interest respectively. ResultsOf the 371 patients studied, 203 (54.7%) had PH while 168 (45.3%) did not. Patients with PH had higher Charlson Comorbidity Score with higher rates of multiple baseline comorbidities. They also had worse multi-chamber enlargement, left ventricular diastolic dysfunction, right ventricular systolic dysfunction, and valvular heart disease compared to non-PH patients. Rates of survival to discharge (11.5% vs 10.9%, p = 0.881) and favorable neurologic outcome (8.0% vs 6.2%, p = 0.550) were similar in PH and non-PH patients respectively. In multivariable analysis, PH was not associated with survival to discharge (OR 1.23, 95%CI 0.57–2.65) or favorable neurologic outcome (OR 1.69, 95%CI 0.64–4.45). ConclusionsIn this contemporary registry of adults with IHCA, while PH was associated with a higher risk patient profile, it was not associated with survival or neurologic outcomes in this population.

Advances in the study of optimum chest compression point for adult cardiopulmonary resuscitation

Chest compressions are a key component of cardiopulmonary resuscitation (CPR). The determination of the optimal compression point (OCP) in adult CPR is an indispensable critical factor for high quality chest compressions (CCs). At present, the OCP for adult CPR is still controversial, which still needs further research and discussion. To provide theoretical reference for determining the OCP, this paper reviews the research progress of the OCP of adult CPR from the development process of compression point and hemodynamic mechanism, so as to improve the quality of CCs and the outcome of cardiac arrest (CA) patients.

Hyperoxia and mortality in conventional versus extracorporeal cardiopulmonary resuscitation.

Hyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. Study-objective was to examine the association between hyperoxia and 30-day mortality in a mixed cohort of two different modes of Cardiopulmonary Resuscitation (CPR): Extracorporeal (ECPR) vs. Conventional (CCPR). In this retrospective cohort study of CA patients admitted to a tertiary level CA centre in Australia (over a 6.5-year time period) mean arterial oxygen levels (PaO2) and episodes of extreme hyperoxia (maximum of mean PaO2 ≥ 300 mmHg) were analysed over the first 8 days post CA. One hundred and sixty-nine post CA patients were assessed (ECPR n = 79 / CCPR n = 90). Mean PaO2-levels were higher in the ECPR vs CCPR group (211 mmHg ± 58.4 vs 119 mmHg ± 18.1; p < 0.0001) as was the proportion with at least one episode of extreme hyperoxia (74.7% vs 16.7%; p < 0.001). After adjusting for confounders and the mode of CPR any episode of extreme hyperoxia was independently associated with a 2.52-fold increased risk of 30-day mortality (OR: 2.52, 95% CI: 1.06-5.98; p = 0.036). We found extreme hyperoxia was more common in ECPR patients in the first 8 days post CA and independently associated with higher 30-day mortality, irrespective of the CPR-mode.

P043 Impact of the COVID-19 pandemic on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand

P043 Impact of the COVID-19 pandemic on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand

P010 Emergency Department Point-of-Care Tests during Cardiopulmonary Resuscitation to Predict Cardiac Arrest Outcomes

P010 Emergency Department Point-of-Care Tests during Cardiopulmonary Resuscitation to Predict Cardiac Arrest Outcomes

OR24 Impact of the Coronavirus 2019 Pandemic on Pediatric Out of Hospital Cardiac Arrest Outcomes During 2020

OR24 Impact of the Coronavirus 2019 Pandemic on Pediatric Out of Hospital Cardiac Arrest Outcomes During 2020

Resuscitation guideline highlights.

The purpose of this review was to give an overview of the most significant updates in resuscitation guidelines and provide some insights into the new topics being considered in upcoming reviews. Recent updates to resuscitation guidelines have highlighted the importance of the earlier links in the chain-of-survival aimed to improve early recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. Empowering lay rescuers with the support of emergency medical dispatchers or telecommunicators and engaging the community through dispatching volunteers and Automated External Defibrillators, are considered key in improving cardiac arrest outcomes. Novel CPR strategies such as passive insufflation and head-up CPR are being explored, but lack high-certainty evidence. Increased focus on survivorship also highlights the need for more evidence based guidance on how to facilitate the necessary follow-up and rehabilitation after cardiac arrest. Many of the systematic and scoping reviews performed within cardiac arrest resuscitation domains identifies significant knowledge gaps on key elements of our resuscitation practices. There is an urgent need to address these gaps to further improve survival from cardiac arrest in all settings. A continuous evidence evaluation process for resuscitation after cardiac arrest is triggered by new evidence or request by the resuscitation community, and provides more current and relevant guidance for clinicians.