Elsevier

Resuscitation

Volume 145, December 2019, Pages 95-150
Resuscitation

ILCOR Summary Statement
2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations,☆☆

https://doi.org/10.1016/j.resuscitation.2019.10.016Get rights and content

Abstract

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.

Section snippets

Dispatcher instruction in CPR: DA-CPR—adults

The emergency medical dispatcher is an essential link in the chain of survival.13, 14 In addition to dispatching emergency medical services (EMS) resources to medical emergencies, emergency medical dispatchers are increasingly being trained to recognize cardiac arrest, to assist bystanders in initiating resuscitation, and to support bystanders in optimizing resuscitation efforts. The international community is continuing to explore ways to increase bystander CPR for cardiac arrests. One such

Advanced airway interventions during adult cardiac arrest

It is important to identify those airway interventions most likely to improve outcomes for both OHCA and IHCA. Chest compressions alone do not provide adequate ventilation during prolonged cardiac arrest. Airway management is therefore required to facilitate ventilation and to reduce the risk of gastric regurgitation and aspiration. The best airway strategy for improving patient outcomes is uncertain. On the basis of the evidence available at the time, the 2015 CoSTR suggested using either an

Pediatric life support

The Pediatric Life Support Task Force reviewed 4 topics for this 2019 CoSTR: DA-CPR, advanced airway interventions in pediatric cardiac arrest, ECMO CPR (ECPR), and TTM during post–cardiac arrest care. An SR was published for each of these topics.3, 6, 7, 8 The Pediatric Life Support Task Force then reviewed the SR and the studies identified by the SR and generated a CoSTR that was posted on the ILCOR website for public comments for each topic. This document contains a summary of the 4 CoSTRs,

Initial oxygen concentration for term infants at birth

Administration of high oxygen concentrations leads to free radical formation and may be toxic to lungs, eyes, brains, and other organs of the newborn.151, 152 In 2010, the ILCOR NLS Task Force CoSTR update noted that it was best to start with 21% oxygen when term newborns received positive-pressure ventilation in the delivery room. The recommendation was based on a meta-analysis that found lower mortality when room air instead of 100% oxygen was used.153 The evidence review for this question

CACs versus non-CACs

CACs are hospitals providing evidence-based resuscitation treatments, including emergency interventional cardiology, bundled critical care with TTM, and protocolized cardiorespiratory support and prognostication.48, 63

This population, intervention, comparator, outcome, study design, and time frame was prioritized for review by the EIT and ALS Task Forces on the basis of the publication of several large registry studies188, 189 since the 2015 ILCOR ALS48, 63 and EIT CoSTRs.190, 191 In the

Presyncope

Presyncope, or near-syncope, is the prodrome of syncope and is characterized by light-headedness, nausea, diaphoresis, and a feeling of impending loss of consciousness. A progression to syncope results in global cerebral hypoperfusion and transient loss of consciousness; loss of postural tone can result in physical injury in up to 30% of patients.214 This review evaluated nonpharmacological first aid interventions that can be applied at the onset or immediately after the onset of presyncope

Disclosures

Writing group disclosures

Writing group memberEmploymentResearch grantOther research supportSpeakers’ Bureau/HonorariaExpert witnessOwnership interestConsultant/advisory boardOther
Jasmeet SoarSouthmead Hospital North Bristol NHS Trust (United Kingdom)NoneNoneNoneNoneNoneNoneNone
Richard AickinStarship Children’s Hospital (New Zealand)NoneNoneNoneNoneNoneNoneNone
Lars W. AndersenAarhus University (Denmark)Amomed Pharma GmbH (PI on a clinical trial involving vasopressin and methylprednisolone. The

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    This article has been copublished in Circulation.

    ☆☆

    Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

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