Elsevier

Resuscitation

Volume 75, Issue 3, December 2007, Pages 400-411
Resuscitation

Statement paper
Scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care identified during the 2005 International Consensus Conference on ECC and CPR Science with Treatment Recommendations: A Consensus Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Stroke Council; and the Cardiovascular Nursing Council

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Introduction

New guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) were published in November 2005.1, 2 Publication followed a systematic evaluation of scientific evidence that culminated in the 2005 International Consensus Conference on ECC and CPR Science with Treatment Recommendations hosted by the American Heart Association (AHA) in January 2005.3, 4 The new treatment recommendations from this meeting incorporated scientific advances made after publication of the 2000 guidelines and were published with the expectation that their worldwide implementation would help improve rates of survival from cardiac arrest and other life-threatening cardiopulmonary emergencies.

A new cycle of evidence evaluation has begun and is expected to be completed in 2010 with the publication of new and revised treatment recommendations. These recommendations will once again reflect the scientific knowledge gained during the intervening period. As the cycle begins, a unique opportunity exists to identify areas in greatest need of clinical research, with the expectation that key questions asked today may be answered in time for the 2010 guidelines. To this end, valuable information was obtained during the evidence evaluation process that led to the 2005 guidelines. Experts appointed to review specific resuscitation topics were asked not only to summarise the existing science but also to identify knowledge gaps. As a result, experts identified knowledge gaps in 276 pre-assigned topics. We have compiled and organised these knowledge gaps and, through a process of consultation and consensus, identified areas of priority for clinical research.

Section snippets

Methods

Member organisations of the International Liaison Committee on Resuscitation (ILCOR), which includes the AHA, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Resuscitation Council of Southern Africa, the Australia and New Zealand Committee on Resuscitation, and the Inter-American Heart Foundation, planned the process of evidence evaluation for the January 2005 evidence-based consensus conference on CPR and ECC.3 ILCOR representatives established task forces on

Research priorities in resuscitation of adults, children, and neonates

The research priorities for adults, children, and neonates (Table 1) were combined because of substantial overlap among these age groups. The overlap was most evident in topics related to adult and paediatric resuscitation. Age-related differences and unique research priorities in the neonatal group were noted under each research priority. The original lists of knowledge gaps and priorities for each age group – as indicated in Methods – can be found in the online-only Data Supplement. The

Research priorities in acute coronary syndromes

Categories of research priorities in acute coronary syndromes (Table 2) included prehospital and emergency department assessment, antiplatelet drugs, heparin, beta-adrenergic blockers, and reperfusion strategies. “Prehospital and emergency department assessment” focused on the use of the 12-lead ECG in patients with ST-segment-elevation myocardial infarction. “Antiplatelet drugs” emphasised the need to determine the optimal dose of clopidogrel and the time dependency of prehospital

Research priorities in stroke

Categories of research priorities in stroke (Table 3) included stroke centres, pharmacological interventions, metabolic management, neuroprotective therapies, transient ischaemic attack, and intracerebral haemorrhage. “Stroke centres” identified the need to assess the safety and efficacy of stroke centres and to determine appropriate triage protocols. “Pharmacological interventions” highlighted blood pressure management, use of intravenous recombinant tissue plasminogen activator, and local

Research priorities in first aid

Categories of research priorities in first aid (Table 4) included bleeding, joint injury, skin burns, bone fracture, spinal injury, local cold injury, snake bite, oral poisoning, allergic reaction, and oxygenation. “Bleeding” highlighted the need to evaluate the safety and efficacy of tourniquets and of novel technologies for control of bleeding. “Joint injury” and “skin burns” highlighted various issues related to cold therapy. “Bone fracture” identified the need to assess the impact of

Discussion

The clinical research priorities identified in the present statement are the result of a process of consensus and consultation among experts and reflect unresolved clinical problems related to resuscitation and emergency management of acute coronary syndromes, stroke, and first aid. New scientific information is needed about prevention, recognition, treatment, monitoring, outcomes evaluation, ethics, and education. These research priorities are being published to help guide decision making by

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    This article has been co-published in Circulation, 20 November, 2007.

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