International Liaison Committee On Resuscitation Research Articles

A Customizable Digital Cognitive Aid for Neonatal Resuscitation: A Simulation-Based Randomized Controlled Trial.

Adherence to the International Liaison Committee on Resuscitation (ILCOR) algorithm optimizes the initial management of critically ill neonates. In this randomized controlled trial, we assessed the impact of a customizable sequential digital cognitive aid (DCA), adapted from the 2020 ILCOR recommendations, compared with a poster cognitive aid (standard of care [SOC]), on technical and nontechnical performance of junior trainees during a simulated critical neonatal event at birth. For this prospective, bicentric video-recorded study, students were recruited on a voluntary basis, and randomized into groups of 3 composed of a pediatric resident and two midwife students. They encountered a simulated cardiac arrest at birth either (1) with DCA use and ILCOR algorithm poster displayed on the wall (intervention group) or (2) with sole ILCOR algorithm poster (poster cognitive aid [SOC]). Technical and nontechnical skills (NTS) between the two groups were assessed using a standardized scoring of videotaped performances. A neonate specific NTS score was created from the adult Team score. 108 students (36 groups of three) attended the study, 20 groups of 3 in the intervention group and 16 groups of 3 in the poster cognitive aid (SOC) group. The intervention group showed a significant improvement in the technical score (P < 0.001) with an average of 24/27 points (24.0 [23.5-25.0]) versus 20.8/27 (20.8 [19.9-22.5]) in poster cognitive aid (SOC) group. No nontechnical score difference was observed. Feedback on the application was positive. During a simulated critical neonatal event, use of a DCA was associated with higher technical scores in junior trainees, compared with the sole use of ILCOR poster algorithm.

Thermoregulation for very preterm infants in the delivery room: a narrative review.

Abnormal temperature in preterm infants is associated with increased morbidity and mortality. Infants born prematurely are at risk of abnormal temperature immediately after birth in the delivery room (DR). The World Health Organization (WHO) recommends that the temperature of newly born infants is maintained between 36.5-37.5oC after birth. When caring for very preterm infants, the International Liaison Committee on Resuscitation (ILCOR) recommends using a combination of interventions to prevent heat loss. While hypothermia remains prevalent, efforts to prevent it have increased the incidence of hyperthermia, which may also be harmful. Delayed cord clamping (DCC) for preterm infants has been recommended by ILCOR since 2015. Little is known about the effect of timing of DCC on temperature, nor have there been specific recommendations for thermal care before DCC. This review article focuses on the current evidence and recommendations for thermal care in the DR, and considers thermoregulation in the context of emerging interventions and future research directions. IMPACT: Abnormal temperature is common amongst very preterm infants after birth, and is an independent risk factor for mortality. The current guidelines recommend a combination of interventions to prevent heat loss after birth. Despite this, abnormal temperature is still a problem, across all climates and economies. New and emerging delivery room practice (i.e., delayed cord clamping, mobile resuscitation trolleys, early skin to skin care) may have an effect on infant temperature. This article reviews the current evidence and recommendations, and considers future research directions.

Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials.

Cardiopulmonary resuscitation (CPR) research traditionally focuses on survival. In 2018, the International Liaison Committee on Resuscitation (ILCOR) proposed more patient-centered outcomes. Our narrative review assessed clinical trials after 2018 to identify the trends of outcome metrics in the field OHCA research. We performed a search of the PubMed database from 1 January 2019 to 22 September 2023. Prospective clinical trials involving adult humans were eligible. Studies that did not report any patient-related outcomes or were not available in full-text or English language were excluded. The articles were assessed for demographic information and primary and secondary outcomes. We included 89 studies for analysis. For the primary outcome, 31 (35%) studies assessed neurocognitive functions, and 27 (30%) used survival. For secondary outcomes, neurocognitive function was present in 20 (22%) studies, and survival was present in 10 (11%) studies. Twenty-six (29%) studies used both survival and neurocognitive function. Since the publication of the COSCA guidelines in 2018, there has been an increased focus on neurologic outcomes. Although survival outcomes are used frequently, we observed a trend toward fewer studies with ROSC as a primary outcome. There were no quality-of-life assessments, suggesting a need for more studies with patient-centered outcomes that can inform the guidelines for cardiac-arrest management.

Expert opinion on evidence after the 2020 Korean Cardiopulmonary Resuscitation Guidelines: a secondary publication.

Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (patient, intervention, comparison, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to COVID-19. Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.

Exhaled CO2 monitoring to guide non-invasive ventilation at birth: a systematic review

ObjectiveMeasuring exhaled carbon dioxide (ECO2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO2 detection for confirming...

Knowledge and Attitudes of First Aid and Basic Life Support Among Public School Teachers in Qassim, Saudi Arabia.

This study aims to address the knowledge gap in first aid and basic life support (BLS) among teachers, expand the targeted schools to elementary and intermediate schools for boys and girls, and develop clear, focused recommendations. Furthermore, to assess the knowledge, skills, and attitude of BLS among schoolteachers in Qassim, Saudi Arabia. This cross-sectional study was conducted in the school year of 2022 to 2023. In Buraidah city and the Uyun AlJiwa and Asyah governorates of Qassim, there are a total of 906 elementary and intermediate schools employing 12,057 teachers (5447 males and 6610 females). A stratified random sampling method was used with a self-administered Arabic questionnaire. This questionnaire included multiple parts (sociodemographic data, previous training status, knowledge and skill of BLS, and assessment of the following: attitude to learn and practice CPR; barriers to performing CPR; the presence or lack of previous resuscitation experience in BLS). Data were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were described by frequency and percentage, while continuous variables were described by mean ± SD. A normality test showed that the total knowledge and skills scale was not normally distributed. The Mann-Whitney and Kruskal-Wallis tests were used to compare the mean knowledge and skills scale across variables. The accepted level of significance was below 0.05 (p <0.05). Our study included 482 participants. Only 19.5% (94) had previous CPR training, and 80.9% (76) were trained more than two years prior to this study's data collection. The main reason for participants' fears of applying BLS was the lack of proper knowledge and skills (48.1%). The majority of the teachers, i.e., 71.0% (342), wanted more training in CPR, and 41.1% (198) thought CPR training should be mandatory at school. We found no statistical relationship between attitude toward training and the city or differences in knowledge and skills scores due to the difference in sociodemographic characteristics. Also, we found no statistical relationship between the question'Did you observe CPR on a collapsed patient?'and the city, meaning that the observation of CPR on collapsed patients is independent of the respondent's school location. Significant differences in skills scores were found between those who had CPR observation and those who did not (p = 0.014), in knowledge scores between those who had previous CPR training and those who did not (p = 0.034), and in skills scores between those who had previous CPR training and those who did not (p <0.001). We found no significant differences in knowledge and skills scores according to the place of previous CPR training (p = 0.163 and p = 0.695, respectively). This study reveals that knowledge and skills in BLS among schoolteachers need to be improved. For this reason, we emphasize the inclusion of International Liaison Committee on Resuscitation (ILCOR) recommendations in the curriculum and that they are made periodic and mandatory for teachers. Especially as we found teachers to have a positive attitude and were willing to train and help.

The Ability of First Aid Providers to Recognize Anaphylaxis: A Scoping Review.

Early recognition of anaphylaxis is critical to early treatment and often occurs in the first aid setting. However, the ability of first aid providers to recognize anaphylaxis is unknown. We sought to examine the evidence regarding first aid providers' ability to recognize anaphylaxis. Our scoping review was performed as part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation processes to update the 2020 ILCOR Consensus on Science with Treatment Recommendations. We searched Medline, Embase, Cochrane, and the gray literature from 2010 to September 2022. The population included adults and children experiencing anaphylaxis with a description of any specific symptom to a first aid provider. Recognition of anaphylaxis was the primary outcome. Two investigators (DM and PC) reviewed abstracts and extractedand assessed the data. Discrepancies between the reviewers were resolved by discussion and consensus with the ILCOR First Aid Task Force. Out of 957 hits, 17 studies met inclusion criteria: one review and meta-analysis, two experimental studies, and 14 observational studies. We did not identify any studies that directly addressed our PICOST (Population, Intervention, Control, Outcomes, Study Design, and Timeframe) as none were performed in the first aid setting. Articles included individuals who may be first aid providers as patients and parents (n=5), teachers, students or school staff (n=8), caregivers and patients (n= 2) or nannies (n=1). All included studies were conducted in high-income countries. Our scoping review found that signs and symptoms of anaphylaxis were not specific and did not allow for easy identification by the first aid provider. Studies focused on education (n=10) and protocols (n=2) and found that both could have a positive impact on anaphylaxis recognition and management. While we did not identify any clinical studies that directly addressed the ability of first aid providers to identify anaphylaxis, future studies examining education methods and action plans may help improve the identification of anaphylaxis by first aid providers.

Reevaluating the Latency Period Between CPR Recertifications Among Non–Allied Healthcare Providers

Cardiopulmonary Resuscitation, or CPR, is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies such as a heart attack, stroke, choking or drowning, in which someone’s breathing and heartbeat has stopped. Under the guidelines put forth by the International Liaison Committee on Resuscitation (ILCOR) and the Emergency Cardiovascular Care organization (ECC), the American Red Cross and American Heart Association, the two largest CPR certification organizations in the US, currently require that an individual’s CPR certification be renewed every two-years. However, an increasing amount of data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training and certification to maintain CPR proficiency levels.

[Basics and novelties of neonatal resuscitation].

This recommendation summarizes the recent neonatal resuscitation guidelines of the European Resuscitation Council (ERC), but it takes into account the guidelines of the American Heart Association (AHA) and the statements of the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTR) for neonatal life support. The goal of the management of the newly born infants is to support the cardiorespiratory transition. Personnel and equipment should be prepared for neonatal life support before every delivery. After birth, the heat loss of the newborn must be prevented and, if possible, the clamping of the cord should be delayed. Initially the newborn must be assessed and, if possible, the baby should be kept with the mother in skin-to-skin contact. The infant must be placed under radiant warmer and the airways must be opened, if respiratory or circulatory support is needed. Decisions about the further steps of resuscitation are based on the evaluation of breathing, heart rate and oxygen saturation. If the baby is apnoeic or has a low heart rate, positive pressure ventilation must be started. The effectiveness of the ventilation must be checked, and failures are to be corrected if necessary. If the heart rate is <60/min despite effective ventilation, chest compressions should be started. Rarely, administration of medications is also necessary. After successful resuscitation, post-resuscitation care must be started. In the case of unsuccessful resuscitation, discontinuing management can be considered. Orv Hetil. 2023; 164(12): 474-480.

Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O2 to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O2 based on pulse oximetry (SpO2) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O2 with titration based on preductal SpO2, abrupt or rapid weaning of inspired O2 to 21% after ROSC or use of 21% O2 during CC followed by upward titration of inspired O2 to achieve target SpO2 after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O2 from 100% O2 after ROSC resulted in supraphysiological PaO2 and higher cerebral oxygen delivery compared to 21% O2 during CC or 100% O2 during CC followed by abrupt weaning to 21% O2 after ROSC. The use of 21% O2 during CC was associated with very low PaO2 after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O2 during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O2 after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation.

Three-year trends in out-of-hospital cardiac arrest across the world: Second report from the International Liaison Committee on Resuscitation (ILCOR)

BackgroundThe International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. MethodsWe invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. ResultsEleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. ConclusionWe observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.

Con: We Should Not Routinely Intubate All Patients in Cardiac Arrest

The International Liaison Committee on Resuscitation (ILCOR) and the European Resuscitation Council (ERC) advocate a stepwise approach to airway management in cardiac arrest and if an advanced airway is required, proficient practitioners should preferentially employ tracheal intubation.1 Whilst there are numerous benefits to placement of a tracheal tube (TT), there are foreseeable situations in which tracheal intubation is not necessary and arguably there may be some benefit in alternative airway management, at least during initial resuscitation. This author proposes that even for the advanced responder, as anesthesiologists and intensive care physicians, the decision to site a TT should not be routine and should instead be reserved for select cases.

Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case

ObjectiveThe International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students. MethodsForty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used. ResultsWhen using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue. ConclusionsAudio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.

A Commentary on the Effect of Targeted Temperature Management in Patients Resuscitated from Cardiac Arrest.

The members of the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force have written a comprehensive summary of trials of the effectiveness of induced hypothermia (IH) or targeted temperature management (TTM) in comatose patients after cardiac arrest (CA). However, in-depth analysis of these studies is incomplete, especially since there was no significant difference in primary outcome between hypothermia versus normothermia in the recently reported TTM2 trial. We critically appraise trials of IH/TTM versus normothermia to characterize reasons for the lack of treatment effect, based on a previously published framework for what to consider when the primary outcome fails. We found a strong biologic rationale and external clinical evidence that IH treatment is beneficial. Recent TTM trials mainly included unselected patients with a high rate of bystander cardiopulmonary resuscitation. The treatment was not applied as intended, which led to a large delay in achievement of target temperature. While receiving intensive care, sedative drugs were likely used that might have led to increased neurologic damage as were antiplatelet drugs that could be associated with increased acute stent thrombosis in hypothermic patients. It is reasonable to still use or evaluate IH treatment in patients who are comatose after CA as there are multiple plausible reasons why IH compared to normothermia did not significantly improve neurologic outcome in the TTM trials.

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium.

HomeJournal of the American Heart AssociationVol. 11, No. 19Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium Open AccessNewsPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialOpen AccessNewsPDF/EPUBLatest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium Clark G. Owyang, Rana Abualsaud, Sachin Agarwal, Marina Del Rios, Anne V. Grossestreuer, James M. Horowitz, Nicholas J. Johnson, Pavitra Kotini‐Shah, Oscar J. L. Mitchell, Ryan W. Morgan, Ari Moskowitz, Sarah M. Perman, Jon C. Rittenberger, Kelly N. Sawyer, Eugene Yuriditsky, Benjamin S. Abella and Felipe Teran Clark G. OwyangClark G. Owyang https://orcid.org/0000-0001-9435-2944 , Division of Pulmonary and Critical Care Medicine, , Weill Cornell Medicine/New York Presbyterian Hospital, , New York, , NY, , Department of Emergency Medicine, , Weill Cornell Medicine/New York Presbyterian Hospital, , New York, , NY, Search for more papers by this author , Rana AbualsaudRana Abualsaud , Department of Emergency Medicine, , Weill Cornell Medicine/New York Presbyterian Hospital, , New York, , NY, Search for more papers by this author , Sachin AgarwalSachin Agarwal , Division of Neurocritical Care & Hospitalist Neurology, , Columbia University Irving Medical Center, , New York, , NY, Search for more papers by this author , Marina Del RiosMarina Del Rios https://orcid.org/0000-0002-7461-4836 , Department of Emergency Medicine, , University of Iowa, , Iowa City, , IA, Search for more papers by this author , Anne V. GrossestreuerAnne V. Grossestreuer , Department of Emergency Medicine, , Beth Israel Deaconess Medical Center, , Boston, , MA, Search for more papers by this author , James M. HorowitzJames M. Horowitz https://orcid.org/0000-0002-8220-5434 , Division of Cardiology, Department of Medicine, , NYU Langone Health, , New York, , NY, Search for more papers by this author , Nicholas J. JohnsonNicholas J. Johnson https://orcid.org/0000-0001-9915-0591 , Department of Emergency Medicine and Division of Pulmonary, Critical Care, and Sleep Medicine, , University of Washington, , Seattle, , WA, Search for more papers by this author , Pavitra Kotini‐ShahPavitra Kotini‐Shah https://orcid.org/0000-0003-3037-0312 , Department of Emergency Medicine, , University of Illinois at Chicago, , Chicago, , IL, Search for more papers by this author , Oscar J. L. MitchellOscar J. L. Mitchell https://orcid.org/0000-0002-5331-5562 , Division of Pulmonary, Allergy, and Critical Care Medicine, , University of Pennsylvania, , Philadelphia, , PA, Search for more papers by this author , Ryan W. MorganRyan W. Morgan https://orcid.org/0000-0003-1664-5316 , Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, , Children’s Hospital of Philadelphia, , Philadelphia, , PA, Search for more papers by this author , Ari MoskowitzAri Moskowitz , Division of Critical Care Medicine, , Montefiore Medical Center, , New York, , NY, Search for more papers by this author , Sarah M. PermanSarah M. Perman , Department of Emergency Medicine, , University of Colorado School of Medicine, , Aurora, , CO, Search for more papers by this author , Jon C. RittenbergerJon C. Rittenberger , Department of Emergency Medicine, , Guthrie‐Robert Packer Hospital, Geisinger Commonwealth Medical College, , Scranton, , PA, Search for more papers by this author , Kelly N. SawyerKelly N. Sawyer , Department of Emergency Medicine, , University of Pittsburgh, , Pittsburgh, , PA, Search for more papers by this author , Eugene YuriditskyEugene Yuriditsky , Division of Cardiology, Department of Medicine, , NYU Langone Health, , New York, , NY, Search for more papers by this author , Benjamin S. AbellaBenjamin S. Abella , Department of Emergency Medicine, , Center for Resuscitation Science, University of Pennsylvania, , Philadelphia, , PA, Search for more papers by this author and Felipe TeranFelipe Teran *Correspondence to: Felipe Teran, MD, MSCE, Department of Emergency Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065. Email: E-mail Address: [email protected] https://orcid.org/0000-0003-1137-0800 , Department of Emergency Medicine, , Weill Cornell Medicine/New York Presbyterian Hospital, , New York, , NY, Search for more papers by this author Originally published29 Sep 2022https://doi.org/10.1161/JAHA.122.026191Journal of the American Heart Association. 2022;11:e026191Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: September 29, 2022: Ahead of Print The American Heart Association Resuscitation Science Symposium (ReSS) was held virtually from November 13 to 15, 2021. This report summarizes ReSS programming, including awards, special sessions, and workshops and scientific content organized by topic (ie, intra‐arrest and postarrest care) and plenary session. Subsequent sections include special circumstances of arrest, survivorship, and new developments in mechanical circulatory support. Lastly, selected abstracts and laboratory science are summarized before a concluding year in review.AwardsThe ReSS program committee bestowed multiple awards for significant contributions to resuscitation science. Dr Kazuo Okada, founder of the Japanese Resuscitation Council and cofounder of the Resuscitation Council of Asia, was awarded the Lifetime Achievement Award in Resuscitation Science. The CRITICAL (Comprehensive Registry of In‐Hospital Intensive Care for Out‐of‐Hospital Cardiac Arrest Survival) study investigators received the Ian G. Jacobs Award for International Group Collaboration to Advance Resuscitation Science. The CRITICAL study team first convened in 2012 to collect Japanese prehospital and in‐hospital data, incorporating data on over 2000 patients with out‐of‐hospital cardiac arrest (OHCA) annually, which it now makes accessible to junior investigators for mentored research opportunities. Mary M. Newman, cofounder, president, and chief executive officer of the Sudden Cardiac Arrest Foundation (https://www.sca‐aware.org/), was awarded the Resuscitation Champion Award. Finally, Dr Takahiro Nakashima (University of Michigan) received the 2021 Max Harry Weil Award as a young investigator with significant promise in resuscitation science. He presented the results of his article, Machine Learning Model for Predicting Out‐of‐Hospital Cardiac Arrests Using Meteorological and Chronological Data.ReSS Young Investigator Networking EventAttended by >100 people this year, the ReSS Young Investigator Networking Event was organized by Dr Sarah Perman (University of Colorado) and Dr Sachin Agarwal (Columbia University). Dr Marina Del Rios (University of Iowa) presented A Roadmap for Equity in Resuscitation Outcomes: Barriers, Opportunities, and Future Directions. Finally, 6 moderated breakout networking sessions were hosted to discuss mentorship, advocacy, and grant writing. Young Investigator awards were presented to 25 early career researchers who were within the first 5 years of their academic appointments (Table S1).Joint American Heart Association/Japanese Circulation Society SessionDr Takanori Ikeda (Toho University Medical Center) and Dr David Gaieski (Thomas Jefferson University) moderated the joint American Heart Association and Japanese Circulation Society session, which focused on postarrest targeted temperature management (TTM). Dr Clifton Callaway (University of Pittsburgh) presented TTM and Post Arrest Injury Severity in the US, highlighting that TTM efficacy may be optimal for a particular range of post–return of spontaneous circulation (ROSC) severity. Dr Mitsuaki Nishikimi (Nagoya University) presented Recent Experiences With TTM Tailored to Injury Severity, sharing similar findings on the different outcome impacts of TTM based on injury severity. Lastly, Dr Karen Hirsch (Stanford University) gave a presentation entitled Tailoring TTM for Non‐Arrest Brain Injury, providing a historical perspective along with the current trends in TTM use for stroke and traumatic brain injury.Women in Resuscitation Science Networking WorkshopLed by cochairs Dr Katherine Berg and Dr Anne Grossestreuer (both from Beth Israel Deaconess Medical Center), the Women in Resuscitation Networking Workshop brought together female resuscitation scientists from around the world. Dr Betsy Hunt (Johns Hopkins University) presented The Keys to Academic Promotion and A Joyful Life in Academic Medicine, illustrating the importance of intentional decision and the art of saying “no.”INTRA‐ARREST RESEARCHPlenary Session: New Directions in Intra‐Arrest ManagementDr Lars W. Andersen (Aarhus University Hospital, Denmark) presented an in‐depth review of new pharmacologic approaches to advanced cardiovascular life support (ACLS), specifically focusing in intra‐arrest therapies and highlighting the relatively small number of interventions that have been translated from animal research into clinical studies.1 Among these, cyclosporine and sodium nitrite are 2 of the agents evaluated in patients with OHCA; experimental evidence suggests that these 2 drugs could limit cellular injury after ischemia reperfusion, yet neither of them are currently linked to an improvement in rates of ROSC or clinical outcomes in clinical trials.2, 3 Shenfu, a traditional Chinese medicine, has also been tested in patients with OHCA, with early trial evidence that suggests a potential benefit. The therapeutic combination of vasopressin and methylprednisolone has also been tested in clinical trials and demonstrated improvement of ROSC rates but not in clinical outcomes.4, 5Dr Peter J. Kudenchuck (University of Washington) provided a review on defibrillation dosing during cardiac arrest resuscitation. Defibrillation is highly time‐ and quality‐dependent, with effectiveness falling 7% to 10% per minute in the absence of cardiopulmonary resuscitation (CPR), and 3% to 4% per minute when CPR is performed.6 Laboratory and clinical studies have suggested that applying additional physical pressure to defibrillation pads can reduce impedance and improve shock effectiveness. Double sequential external defibrillation has been studied in a trial of patients with refractory ventricular fibrillation (VF), finding that double sequential external defibrillation was associated with higher rates of defibrillation success compared with standard defibrillation.7 In addition to optimizing CPR quality and shock delivery, stabilizing the arrhythmia substrate with the use of antiarrhythmic agents, and the treatment of underlying factors such as coronary ischemia, remain critical in the treatment of refractory ventricular fibrillation.Dr Dana Edelson (University of Chicago) presented on the outcomes for patients with COVID‐19 cardiac arrest. She highlighted factors contributing to increased incidence of both in‐hospital cardiac arrest (IHCA) and OHCA rates, lower survival rates, lower emergency response times, and overall lower ROSC and survival. Because CPR has the potential to be an aerosol‐generating procedure, special task forces of the American Heart Association and International Liaison Committee on Resuscitation (ILCOR) provided expert consensus recommendations to maintain the quality of resuscitation care while prioritizing the safety of health care practitioners.8, 9Closing the session, Dr Tom P. Aufderheide (Medical College of Wisconsin), presented a report on the National Heart, Lung, and Blood Institute–sponsored Extracorporeal Cardiopulmonary Resuscitation (ECPR) for OHCA Workshop held virtually on August 23 to 24, 2021. This workshop was intended to review the current state of the science and identify high‐priority research gaps and opportunities. The group discussed various aspects of extracorporeal membrane oxygenation (ECMO)‐facilitated cardiac arrest resuscitation research, including study designs, patient selection, and protocols. It was estimated that if ECMO‐facilitated resuscitation were to be implemented broadly, it could save 18 000 patients per year with functionally favorable survival outcomes in the United States alone. ECPR research has shown that the potential for recovery from ischemic insult is much greater than generally recognized, representing a window of opportunity for new and more effective interventions.Original Science Presentation Session: New Insights for Intra‐Arrest ManagementDr Frederick J. Brown (Washington University) presented a Bayesian reanalysis of the ALPS (Amiodarone, Lidocaine, or Placebo Study in Out‐of‐Hospital Cardiac Arrest) data showing a favorable risk difference for neurologically favorable survival (modified Rankin score ≤3) with antiarrhythmics versus placebo (Table 1). Antiarrhythmics likely lead to increased probability of neurologically intact survival but with small magnitude of benefit. Dr Masashi Okubo (University of Pittsburgh) investigated intra‐arrest transport versus continued on‐scene resuscitation in pediatric OHCA using the ROC (Resuscitation Outcomes Consortium) Epistry data set from 11 sites in the United States and Canada, with no significant difference noted in survival to discharge. Dr Shengyuan Luo (Rush University) presented data on early versus late administration of epinephrine in adults with shockable rhythm OHCA. After adjustment across subgroups, patients receiving late epinephrine (>4 minutes between defibrillation and dose) had lower odds of prehospital ROSC, survival to hospital discharge, and favorable neurological outcome at discharge. Using an observational cohort of post‐ROSC adults with OHCA, Dr Betty Yang (University of Washington) investigated whether the association between increasing epinephrine dose and functional survival from OHCA is modified by TTM. A significant interaction between epinephrine dose and TTM status was found showing the relative benefit of TTM increased with increasing number of epinephrine doses.Table 1. Original Science Presentation Session: New Insights for Intra‐Arrest ManagementLecturePresenterCountryAntiarrhythmic use and the posterior probability of neurologically intact survival in a reanalysis of the amiodarone, lidocaine, or placebo study in out‐of‐hospital cardiac arrestFrederick J. BrownUSAAssociation of intra‐arrest transport versus continued on‐scene resuscitation with survival to hospital discharge among pediatric patients with out‐of‐hospital cardiac arrestMasashi OkuboUSAEarly compared to late administration of epinephrine in adults with shockable initial rhythm out‐of‐hospital cardiac arrestShengyuan LuoUSADoes targeted temperature management modify the association between increasing epinephrine dose and survival outcomes following out‐of‐hospital cardiac arrest?Betty YangUSAPOSTARREST RESEARCHPlenary Session: Updates in Postarrest TTMThe conference plenary session on TTM opened with moderators Drs. Maaret Castren (Helsinki University Hospital) and Yew Woon Chia (National Healthcare Group). Dr Niklas Nielsen (Lund University) presented the recent TTM2 trial (Hypothermia versus Normothermia after Out‐of‐Hospital Cardiac Arrest),10 which randomized adults with OHCA and presumed cardiac or unknown cause to hypothermia (33 °C) versus controlled normothermia for 24 hours, finding no difference in 6‐month all‐cause mortality or neurological outcome. More cardiac arrythmias requiring intervention were observed in the hypothermia arm, but otherwise, no difference in adverse events was noted. Several criticisms of the trial were addressed including time to goal temperature and illness severity compared with other studies.Dr Nicholas Johnson (University of Washington) provided historical context for the evolving evidence, suggesting potential real‐world worsening in OHCA outcomes after the first TTM trial.11, 12, 13, 14 He reviewed recent literature demonstrating an interaction between illness and brain injury severity and dose of TTM,15, 16, 17, 18 with recommendations that future trials enrich their populations with those most likely to benefit from TTM and other therapies based on illness severity.Dr Jerry Nolan (Royal United Hospital) discussed normothermia as a possible new standard after cardiac arrest. After reviewing historical temperature management recommendations from ILCOR, he summarized a new systematic review and meta‐analysis,19 concluding that TTM at 32 °C to 34 °C did not result in improved outcome compared with normothermia. The ILCOR taskforce recommended that fever should be actively prevented by targeting temperature ≤37.5 °C, and again acknowledged that there may be subpopulations who would benefit from lower temperatures.Dr Alexis Topjian (University of Pennsylvania) discussed 2 major randomized trials in pediatric IHCA and OHCA, neither of which demonstrated benefit with cooling to 33 °C compared with normothermia.20, 21 Dr Topjian then highlighted the importance of long‐term neurocognitive and behavioral outcomes, discussing a new trial testing the duration of TTM in children with a 1‐year primary outcome of an ordinal behavioral score.Original Science Presentation Session: Postarrest Care Beyond TTMDr Martin Meyer (Copenhagen University Hospital) discussed a substudy of the interleukin (IL)‐6 IMICA (Inhibition for Modulating Inflammation After Cardiac Arrest) trial.22 The authors reported that IL‐5 and IL‐6 levels were higher in the tocilizumab arm as compared with the placebo arm at all analyzed postrandomization time points. The authors hypothesized that the higher IL‐6 levels and the lower C‐reactive protein levels in patients randomized to tocilizumab may be explained by occupation of the IL‐6 receptor by tocilizumab (Table 2). Dr Alexandra Weissman (University of Pittsburgh) described a novel study exploring the use of nanopore genetic sequencing for the identification of bacterial infection in initial survivors of cardiac arrest. Infection following cardiac arrest can be difficult to diagnose because of concurrent inflammation from ischemia–reperfusion injury as well as other postarrest factors. Nanopore sequencing technology returned results more quickly than standard microbiologic approaches, but with similar pathogen detection. Dr Ericka Fink (University of Pittsburgh) reported on neuroprognostication via early results from the POCCA (Personalizing Outcomes After Child Cardiac Arrest) study. Among 164 initial survivors of pediatric cardiac arrest at 14 pediatric intensive care units, survival with favorable Vineland Adaptive Behavior Scale scores (>70) at 1 year was best predicted by neurofilament light chain and ubiquitin carboxyl‐terminal esterase‐L1 (UCH‐L1). Dr Aris Karatasakis (University of Washington) reported on early (within 6 hours), head‐to‐pelvis ECG‐gated computed tomography angiogram (computed tomography first) imaging after sudden cardiac arrest.23 The following injuries were observed among the 104 sudden cardiac arrest victims: rib fractures (74%), sternal fractures (18%), pulmonary contusions (13%), mediastinal hematomas (10%), liver or spleen lacerations (6%), pneumothoraces (5%), pulmonary lacerations (3%), mainstem intubations (2%), and hemopericardium (1%). Similar rates of injury were seen among the 27% of patients who received mechanical chest compressions compared with those who received standard chest compressions only.Table 2. Original Science Presentation Session: Beyond Targeted Temperature ManagementLecturePresenterCountryChanges in cytokine responses by treatment with tocilizumab in OHCAMartin MeyerDenmarkReal‐time nanopore sequencing for bacterial pneumonia after OHCAAlexandra WeissmanUSAPersonalizing outcomes after child cardiac arrest: a preliminary biomarker reportEricka L. FinkUSAPrevalence and patterns of resuscitation‐associated industry detected by head‐to‐pelvis computed tomography after OHCA resuscitationAris KaratasakisUSAOHCA indicates out‐of‐hospital cardiac arrest.SPECIAL CIRCUMSTANCESPlenary Session: Special Circumstances in ResuscitationDr Carolyn Zelop (New York University) highlighted that US maternal mortality in cardiac arrest has increased >50% in the past 25 years, the highest rate of all developed nations.24 Maternal cardiac arrest requires an understanding of physiological changes during pregnancy and a modified ACLS algorithm to account for the management of 2 patients. Dr Todd Kilbaugh (University of Pennsylvania) presented on mitochondrial function in mediating neurologic outcomes in post–cardiac arrest animal models,25, 26 neurometabolic optical monitoring devices for cerebral metabolism,27 and advanced approaches to neuroimaging and biomarkers for prognostication after neurologic insult. Focusing on postarrest neuroprognostication, Dr Hirsch (Stanford University) described how withdrawal of life‐sustaining treatment represents the majority of avoidable deaths because of perceptions of poor prognosis. Current neuroprognostication studies are limited by sample size, study design, and postarrest care, but ongoing research aims to predict patient outcome after cardiac arrest. Dr Horowitz (New York University) discussed the underrecognized role that pulmonary embolism plays in cardiac arrest. Though the mainstay of therapy is systemic thrombolysis, there have been recent advances in the intra‐arrest management of pulmonary embolism, including catheter directed therapies and venoarterial ECMO.Plenary Session: Survivorship—Current Needs and Knowledge GapsSurvivorship and recovery after cardiac arrest begins with resuscitation and may span years for patients, families, and care providers. Awareness and advocacy for comprehensive recovery expectations at hospital discharge and referral to specialty rehabilitation resources have increased with recent 2020 American Heart Association guidelines.28 Dr Sachin Agarwal (Columbia University) presented on ongoing studies to characterize the role of psychological well‐being on the long‐term quality of life and cardiovascular prognosis after cardiac arrest. He discussed behavioral intervention studies aimed to alleviate fear of recurrence and death along with work on intensive rehabilitation and postdischarge clinics. Dr Susanne Muehlschlegel (University of Massachusetts Medical School) discussed the forgotten stakeholders in brain injury: the family and providers. She presented results from a 2‐phase qualitative study through a National Institutes of Health (NIH)‐sponsored virtual workshop to understand the information families need in the first 48 hours after cardiac arrest or traumatic event. This included family needs for emotional, physical, and spiritual support. Dr Sana Al‐Khatib (Duke University) discussed the indications and long‐term management of implantable cardioverter defibrillators. For arrest survivors, implantable cardioverter defibrillators are indicated when reversible causes are not identified and meaningful survival >1 year is anticipated. Additionally, remote monitoring has improved the early detection of arrhythmias, device malfunction, and inappropriate shock delivery. Dr Samantha Fernandez Hernandez (Baylor University College of Medicine) discussed her own 2020 cardiac arrest (during her first year of neurology residency) and 1‐year survivorship journey. Highlighting the cognitive and psychological effects of survivorship and her quick return to her training program, she called for a systematic discussion of recovery expectations and improved access to resources for follow‐up after cardiac arrest.Original Science Presentation Session: Developments in ECPR and ECMODr Daniel Rob (General University Hospital) presented a post hoc analysis of the Prague OHCA trial, where patients with refractory OHCA were randomized to hyperinvasive strategy of ECPR and percutaneous coronary intervention compared with standard care (Table 3). The hyperinvasive strategy resulted in better neurologic outcomes and 180‐day survival compared with standard care; importantly, no patients with initial pulseless electrical activity or asystole survived, suggesting ECPR with immediate percutaneous coronary intervention should be reserved for initial shockable rhythm cohorts. Dr Arianne Agdamag (University of Minnesota) presented Supraglottic Airway Devices Are Associated With Asphyxial Physiology Upon Arrival for ECPR in Patients With Refractory OHCA Treated With Prolonged CPR. Among an initial shockable rhythm cohort potentially eligible for ECPR, supraglottic airways were significantly more likely to fail the predefined resuscitation continuation criterion. Dr Jensyn VanZalen (University of Michigan) presented Impact of Leukocyte Filtration and Leukocyte Modulation on Recovery of Heart Function After Prolonged Cardiac Arrest Treated With ECPR in a Porcine Model. Pigs with induced VF arrest underwent pronged mechanical CPR followed by hours of ECMO support, weaning, and necropsy. During the ECMO phase, the authors tested a leukocyte filter and a leukocyte immunomodulation device in the circuit, but no significant clinical differences (ie, recovery in cardiac function) between devices and control were observed. Dr Emilie Gregers (Copenhagen University Hospital) presented on early lactate clearance and association with survival in refractory OHCA treated with ECPR in Denmark. Among 226 patients with OHCA treated with ECPR over a 9‐year period, survivors showed lower initial lactate levels compared with nonsurvivors. Lactate clearance was higher in survivors at most time points tested, whereas other markers, such as platelets and leukocytes, were not.Table 3. Original Science Presentation Session: Developments in ECPR and Extracorporeal Membrane OxygenationLecturePresenterCountryImmediate percutaneous coronary intervention in patients with refractory out‐of‐hospital cardiac arrestDaniel RobCzech RepublicSupraglottic airway devices are associated with asphyxial physiology upon arrival for ECPR in patients with refractory OHCA treated with prolonged CPRArianne AgdamagUSAImpact of leukocyte filtration and leukocyte modulation on recovery of heart function after prolonged cardiac arrest treated with ECPR in a porcine modelJensyn VanZalenUSAEarly lactate clearance is associated with survival in a national cohort of refractory out‐of‐hospital cardiac arrest patients managed with extracorporeal cardiopulmonary resuscitationEmilie GregersDenmarkCPR indicates cardiopulmonary resuscitation; ECPR, extracorporeal cardiopulmonary resuscitation; and OHCA, out‐of‐hospital cardiac arrest.LATE‐BREAKING ABSTRACTSDr Christian Spaulding (Hôpital Européen Georges‐Pompidou) presented Emergency Versus Delayed Coronary Angiogram in Survivors of Out‐of‐Hospital Cardiac Arrest Without ST Segment Elevation (EMERGE) Trial, which randomized OHCA without ST elevation or obvious cardiac cause to immediate versus delayed (48–96 hours after ROSC) coronary angiography. Stopped early for low enrollment, there was no difference in 180‐day neurologically intact survival nor physiologic or length of stay secondary outcomes. Dr Rudolph Koster (Academic Medical Center, Amsterdam) described the use of a text message alert system to increase lay defibrillation via automated external defibrillator for VF occurring in the home. Adjusted results showed a significant increase in survival with the intervention, although this was not significant in terms of neurologically intact survival. There was also a statistically significant decrease in the proportion of patients who did not receive CPR before emergency medical service's arrival and in the time to defibrillation. Dr Robert Sutton (University of Pennsylvania) reported on results from a randomized multicenter trial of the following quality of care interventions: frequent physiologic‐directed point‐of‐care CPR trainings and monthly debriefing intervention in pediatric in‐hospital cardiac arrest. No statistically significant difference was found with the intervention in terms of survival and neurologic outcomes, but diastolic blood pressure, ventilation rate, and postarrest systolic hypotension did significantly improve. Dr Brian Weil (University at Buffalo) presented data on the effect of triiodothyronine nanoparticles on early postresuscitation brain injury in a porcine model of OHCA. Neuron‐specific enolase increase was significantly lower, and regional neuronal injury and hippocampal ultrastructure damage was attenuated in the 2 groups that received triiodothyronine nanoparticles compared with epinephrine controls. Dr Saket Girotra (University of Iowa) reported the results of a multicenter prospective observational study exploring the impact of suspected or confirmed COVID‐19 infection on IHCA survival using the American Heart Association's Get With The Guidelines‐Resuscitation registry. After adjustment, survival to hospital discharge and acute resuscitation survival was significantly lower in patients with suspected or confirmed COVID‐19 infection. Patients who were COVID‐19 positive were also found to receive significantly more delayed defibrillation but significantly fewer delays in epinephrine than patients who were COVID‐19 negative.BEST OF THE BEST ORAL ABSTRACTSDr James M. Gray (Cincinnati Children's Hospital) used data from the PediRES‐Q (Pediatric Resuscitation Quality) network from 2015 to 2020 at 19 sites to assess the prevalence of inappropriate defibrillation attempts during pediatric IHCA. In 157 events, 380 shocks were delivered; 30% were deemed inappropriate and 13% indeterminate by 2 pediatric cardiologists reviewing preshock rhythms. Dr Jing Li (University of Illinois, Chicago) presented her team's development of TAT‐PHLPP, a

Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country.

The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation. This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271). Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser. Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed. · Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS.. · Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak.. · Large multicentric trial is required to generate robust evidence..

Temperature control after cardiac arrest: friend or foe.

Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32-36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients. The Targeted Temperature Management 2 (TTM-2) trial documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC vs. targeted normothermia. A systematic review and meta-analysis completed by the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) concluded that temperature control with a target of 32-34 °C did not improve survival or favourable functional outcome after cardiac arrest. Two observational studies have documented an association between predicted moderate hypoxic-ischaemic brain injury and better outcome with temperature control at 33-34 oC compared with 35-36 oC. We suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.

ERC-ESICM guidelines on temperature control after cardiac arrest in adults

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research.The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 hours. There was insufficient evidence to recommend for or against temperature control at 32–36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

ERC-ESICM guidelines on temperature control after cardiac arrest in adults.

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research. The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7°C) for at least 72h. There was insufficient evidence to recommend for or against temperature control at 32-36°C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

Community Initiatives to Promote Basic Life Support Implementation-A Scoping Review.

Introduction: Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. Methods: This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. Results: Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. Conclusion: Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes.