International Liaison Committee On Resuscitation Research Articles

CPR Memory and Skill Degradation Among Non-Allied Healthcare Professionals

Cardiopulmonary Resuscitation 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 have 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 currently require that an individual’s CPR certification be renewed every two years. However, data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training to maintain required CPR proficiency levels. Four hundred non-allied healthcare professionals from a school district in central Georgia were CPR-certified under the American Heart Association (AHA) Heart-Saver curriculum. Participants included 153 males and 247 females from elementary, middle, and high school settings. Participants included administrators, teachers, coaches, and staff. Two tenured college professors from the School of Health and Human Performance were responsible for teaching and certifying study participants. Each of these professors possessed a minimum of five years of CPR certification experience with the American Heart Association. Course sizes were limited to 12-15 participants. All CPR certification courses were implemented under standardized, controlled circumstances. Following the initial certification, twenty-five percent of participants were randomly selected to be reassessed at either three, six, nine, or twelve months, respectively, to determine memory and skill degradation rates and patterns. Degradation of declarative and procedural knowledge was observed during subsequent retest sessions at each of the three-, six-, nine-, and twelve-month marks. Scores depreciated approximately 10% each three-month retesting period, to 88%, 79%, 69%, and 57%, respectively. Data suggest that after six months, participants failed to meet the AHA standards for demonstrating acceptable declarative and procedural knowledge related to CPR implementation. Due to the observed degradation in both declarative and procedural knowledge, it is apparent that a more periodic training and recertification process in CPR is required for school-based personnel. A more consistent and periodic approach to preparing school-based first responders may prove beneficial in maintaining CPR proficiency rates, which very well could save lives.

ILCOR pediatric life support recommendations translation to constituent council guidelines: An emphasis on similarities and differences

The International Liaison Committee on Resuscitation (ILCOR) performs rigorous scientific evidence evaluation and publishes Consensus on Science with Treatment Recommendations. These evidence-based recommendations are incorporated by ILCOR constituent resuscitation councils to inform regional guidelines, and further translated into training approaches and materials and implemented by laypersons and healthcare providers in- and out-of-hospital. There is variation in council guidelines as a result of the weak strength of evidence and interpretation. In this manuscript, we highlight ten important similarities and differences in regional council pediatric resuscitation guidelines, and further emphasize three differences that identify key knowledge gaps and opportunity for “natural experiments.”

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.

Dvogodišnji trend vanbolničkog srčanog zastoja u Bosni i Hercegovini

Introduction: Participation in the research under the auspices of the International Liaison Committee on Resuscitation (ILCOR) collected available data on out-of-hospital cardiac arrest (OHCA) for 2016 and 2017 from Bosnia and Herzegovina. Methods: We invited all emergency medical services to voluntarily participate in collecting OHCA data from 2015 to 2017 in Bosnia and Herzegovina (BiH). We received descriptive data on the most important elements of the latest Utstein template recommendations for 2016 and 2017 from the Sarajevo Canton and Tuzla. Results: The research in BiH in 2016 covered 417,498 people or 12.0% of the total population, and in 2017, 529,521 people or 15.0%. The annual incidence of OHCA treated by emergency medical services in BiH was 75.4 in 2016 and 65.0 per 100,000 inhabitants in 2017. The provision of cardiopulmonary resuscitation (CPR) by bystanders was 2.9% in 2016 and 4.1% in 2017. Emergency medical services witnessed OHCA in 2.2% of patients in 2016 and 7.3% in 2017. Survival of OHCA to hospital discharge or 30-day survival of patients treated by emergency medical services in BiH was 12.7% in 2016 and 7.8% in 2017. Conclusion: We observed that there are no national or local registries of out-of-hospital cardiac arrest in BiH in accordance with Utstein recommendations. The extremely low number of initiated CPR by bystanders affects the overall survival rate to hospital discharge and 30-day survival of patients.

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.

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

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.