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2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:
Toward International Consensus on Science:
The International Liaison Committee on Resuscitation (ILCOR) was founded on November 22, 1992, and currently includes representatives from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Council of Southern Africa (RCSA), the InterAmerican Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Its mission is to identify and review international science and knowledge relevant to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and when there is consensus to offer treatment recommendations. Emergency cardiovascular care includes all responses necessary to treat sudden life-threatening events affecting the cardiovascular and respiratory systems, with a particular focus on sudden cardiac arrest.
In 1999, the AHA hosted the first ILCOR conference to evaluate resuscitation science and develop common resuscitation guidelines. The conference recommendations were published in the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.1 Since 2000, researchers from the ILCOR member councils have evaluated resuscitation science in 5-year cycles. The conclusions and recommendations of the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations were published at the end of 2005.2,3 The most recent International Consensus Conference was held in Dallas in February 2010, and this publication contains the consensus science statements and treatment recommendations developed with input from the invited participants.
The goal of every resuscitation organization and resuscitation expert is to prevent premature cardiovascular death. When cardiac arrest or life-threatening emergencies occur, prompt and skillful response can make the difference between life and death and between intact survival and debilitation.
Evidence Evaluation Process:
To begin the current evidence evaluation process, ILCOR representatives established 6 task forces: basic life support (BLS); advanced life support (ALS); acute coronary syndromes (ACS); pediatric life support; neonatal life support; and education, implementation, and teams (EIT). Separate writing groups were formed to coordinate evidence evaluation for defibrillation and mechanical devices because these overlapped with both BLS and ALS. Each task force identified topics requiring evidence evaluation and invited international experts to review them. To ensure a consistent and thorough approach, a worksheet template was created with step-by-step directions to help the experts document their literature reviews, evaluate studies, determine levels of evidence, and develop treatment recommendations. When possible, 2 expert reviewers were invited to perform independent evaluations for each topic. The worksheet authors submitted their search strategies to 1 of 3 worksheet review experts. The lead evidence evaluation expert also reviewed all worksheets and assisted the worksheet authors in ensuring consistency and quality in the evidence evaluation. In conjunction with the International First Aid Science Advisory Board, the AHA established an additional task force to review evidence on first aid. The evidence review followed the same process but was not part of the formal ILCOR review.
The evidence evaluation process from 2005–2010 initially involved 509 worksheet authors with 569 worksheets. Some of the worksheets were merged while in other cases there was no new evidence and the worksheets/topics were deleted. The 2010 International Consensus Conference in February, 2010 involved 313 experts from 30 countries. A final total of 277 specific resuscitation questions, each in standard PICO (Population, Intervention, Comparison, Outcome) format, were considered by 356 worksheet authors who reviewed thousands of relevant, peer-reviewed publications. Many of these worksheets were presented and discussed at monthly or semimonthly task force international web conferences (ie, “webinars” that involved conference calls with simultaneous internet conferencing). Beginning in May 2009 the evidence review and summary portions of the evidence evaluation worksheets, with worksheet author conflict of interest (COI) statements, were posted on the ILCOR Web site (www.ilcor.org). Journal advertisements and emails invited public comment. Persons who submitted comments were required to indicate their potential conflicts of interest. Public comments and potential conflicts of interest were sent to the appropriate ILCOR task force chair and worksheet author for consideration.
To provide the widest possible dissemination of the science reviews performed for the 2010 International Consensus Conference, the worksheets prepared for the conference are linked from this document and can be accessed by clicking on the superscript worksheet numbers (each begins with a letter, typically a 3-letter abbreviation) located adjacent to headings.
During the 2010 Consensus Conference, wireless Internet access was available to all conference participants to facilitate real-time verification of the literature. Expert reviewers presented summaries of their evidence evaluation in plenary and concurrent sessions. Presenters and participants then debated the evidence, conclusions, and draft summary statements. The ILCOR task forces met daily during the conference to discuss and debate the experts' recommendations and develop interim consensus science statements. Each science statement summarized the experts' interpretation of all relevant data on a specific topic, and included consensus draft treatment recommendations. The wording of science statements and treatment recommendations was revised after further review by ILCOR member organizations and the editorial board. This format ensures that the final document represents a truly international consensus process.
At the time of submission this document represented the state-of-the-art science of resuscitation medicine. With the permission of the relevant journal editors, several papers were circulated among task force members if they had been accepted for publication in peer-reviewed journals but had not yet been published. These peer-reviewed and accepted manuscripts were included in the consensus statements.
This manuscript was ultimately approved by all ILCOR member organizations and an international editorial board (listed on the title page of this supplement). Reviewers solicited by the editor of Circulation and the AHA Science Advisory and Coordinating Committee performed parallel peer reviews of this document before it was accepted for publication. This document is being published online simultaneously by Circulation and Resuscitation, although the version in the latter publication does not include the section on first aid.