ILCOR, 2015 and the countdown to new guidelines

8704-000_i-gel_resus_mainAs 2014 draws to a close, it seems a good opportunity to look forward to 2015 and consider what the new year may bring. It does look set to be an interesting year. The inaugural European Games will be held in Baku in June, the 7th Rugby World Cup will take place in England in September and Resuscitation 2015 – The Guidelines Congress, will be held in Prague in October!

Sport can be unpredictable, but the winners of the 2015 Rugby World Cup will almost certainly come from one of just five or six nations. I doubt the new 2015 ERC Resuscitation guidelines will provide us with too many surprises either, and neither should they. The ILCOR Scientific Evidence Evaluation and Review System (SEERS) and Consensus on Resuscitation Science and Treatment Recommendations (CoSTR), from which new guidelines are eventually developed, is a process that should ensure the right questions are asked, the relevant evidence is gathered and reviewed and a consensus on the science is obtained before any treatment recommendations are made. New guidelines then follow.

The ILCOR web-site provides the opportunity to review the current status of the PICO questions. In the Advanced Life Support (ALS) section, two questions in particular caught my attention:

Advanced airway placement (ETT v SGA)

Among adults who are in cardiac arrest in any setting  (P), does tracheal tube insertion as first advanced airway  (I), compared with insertion of a supraglottic airway as first advanced airway  (C), change ROSC, CPR parameters, development of aspiration pneumonia, Survival with Favourable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?

Airway placement (Basic vs Advanced)

Among adults who are in cardiac arrest in any setting (P), does insertion of an advanced airway (ETT or supraglottic airway) (I), compared with basic airway (bag mask +/- oropharyngeal airway) (C), change Survival with Favourable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, CPR parameters, development of aspiration pneumonia (O)?

Both of the above subjects have been discussed in previous blog posts. The subject of ETT v SGA was covered in a post from October 2012 entitled, ‘Supraglottic airways versus tracheal intubation for OHCA’ and the latter in a post from February 2013 entitled, ‘Pre-hospital airway management for patients with OHCA’.

Since these blog posts were written, additional evidence has been published and it will be interesting to see what conclusions there are from the SEERS/CoSTR process.

In the Basic Life Support (BLS) section, one question stood out as of particular interest:

 Passive ventilation techniques

Among adults and children who are in cardiac arrest in any setting (P), does addition of any passive ventilation technique (eg positioning the body, opening the airway, passive oxygen administration) to chest compression-only CPR (I), compared with just chest compression-only CPR (C), change Survival with Favourable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, bystander initiated CPR, oxygenation (O)?

The subject of passive oxygenation has been covered in two blog posts on this site. The first, published in April 2012, asked the question, ‘Should we be passive about oxygenation?’ and the second, in October 2013, entitled, ‘Passive oxygenation – the jury is still out’, concluded that,

‘…whilst there appears to be very little new published data, passive oxygenation remains a subject of lively debate in resuscitation circles and is often mentioned in articles reviewing ventilation strategies and airway management in cardiac arrest. Before it slips from view due to a lack of new evidence, it is hoped a new wave of studies are already in progress and will soon emerge as peer reviewed published studies in the near future, enabling a more conclusive assessment to be made as to whether passive oxygenation has a useful role to play during CPR. Without doubt, at the present time, the jury remains out.’

I will be interested to see the conclusions  from the SEERS/CoSTR process on this very interesting subject.

There are many other questions of interest in the ALS and BLS sections, as well as in the Neonatal, Paediatric and Education sections, including use of Impedance Threshold Devices, Induced Hypothermia and Exhaled CO2 detection and esophageal detection devices.

As a big sports fan, I am looking forward to both the European Games and the Rugby World Cup, as well as the Cricket World Cup. However, even these major upcoming sporting events are not anticipated with quite the same excitement as Resuscitation 2015 – The Guidelines Conference! I just can’t wait!