The evidence supporting AHA guidelines on adult cardiopulmonary resuscitation (CPR).

Autor: Junedahl E; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Lundgren P; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Andersson E; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Gupta V; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Råmunddal T; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Rawshani A; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Rawshani A; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden.; The Swedish Cardiopulmonary Resuscitation Registry, Gothenburg, Sweden., Riva G; Center for Resuscitation Science, Department of Science and Education KI SOS, Karolinska Institutet, Solna, Sweden., Arnetorp I; Department of Molecular and Clinical Medicine, Institute of Medicine University of Gothenburg, Gothenburg, Sweden., Hessulf F; The Swedish Cardiopulmonary Resuscitation Registry, Gothenburg, Sweden., Herlitz J; The Swedish Cardiopulmonary Resuscitation Registry, Gothenburg, Sweden., Djärv T; Center for Resuscitation Science, Department of Science and Education KI SOS, Karolinska Institutet, Solna, Sweden.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Dec 17; Vol. 19 (12), pp. e0309241. Date of Electronic Publication: 2024 Dec 17 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0309241
Abstrakt: Background: Guidelines for the management of cardiac arrest play a crucial role in guiding clinical decisions and care. We examined the strength and quality of evidence underlying these recommendations in order to elucidate strengths and gaps in knowledge.
Methods: Using the 2020 American Heart Association (AHA) Guidelines for Adult CPR, we subdivided all recommendations into advanced life support (ALS), basic life support (BLS), and recovery after cardiac arrest, as well as a more granular categorization by topic (i.e. the intervention or evaluation recommended). The Class of Recommendation (COR) and Level of Evidence (LOE) for each were reviewed. Additionally, we reviewed the 2023 guidelines to ensure the inclusion of the most recent updates.
Results: We noted 254 recommendations, of which 181 were ALS, 69 were BLS, and 4 were recovery after resuscitation. In total, only 2 (1%) had the most robust evidence (LOE A), while 23% were at LOE B-NR (Non-Randomized), 15% at LOE B-R (Randomized), 50% at LOE C-LD (Limited Data), and 12% relied on expert opinion LOE C-EO (Expert Opinion). Despite the strength of ALS recommendations (Class 1, 2a, or 2b), none had LOE A. In BLS, no recommendations were supported by LOE A. For BLS, 7% of recommendations had LOE C (C-LD or C-EO). The evidence for specific BLS topics, such as airway management, was notably low. Among ALS topics, neurological prognostication had relatively stronger evidence.
Conclusions: Only 26 out of the 81 COR 1 recommendations (32%) were supported by LOE A or B, indicating a strong discrepancy between the strength of recommendation and the underlying evidence in cardiac arrest guidelines. The findings underscore a pressing need for more rigorous research, particularly randomized trials.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Junedahl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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