The recommendations in this 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are based on an extensive evidence review process that was begun by the International Liaison Committee on Resuscitation (ILCOR) after the publication of the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 1,2 and was completed in February 2015.3,4

In this in-depth evidence review process, ILCOR examined topics and then generated a prioritized list of questions for systematic review. Questions were first formulated in PICO (population, intervention, comparator, outcome) format,5 and then search strategies and inclusion and exclusion criteria were defined and a search for relevant articles was performed. The evidence was evaluated by the ILCOR task forces by using the standardized methodological approach proposed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group.6

The quality of the evidence was categorized based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). Then, where possible, consensus-based treatment recommendations were created.

To create this 2015 Guidelines Update, the AHA formed 15 writing groups, with careful attention to manage conflicts of interest, to assess the ILCOR treatment recommendations and to write AHA treatment recommendations by using the AHA Class of Recommendation (COR) and Level of Evidence (LOE) system. The recommendations made in the Guidelines are informed by the ILCOR recommendations and GRADE classification, in the context of the delivery of medical care in North America. The AHA writing group made new recommendations only on topics specifically reviewed by ILCOR in 2015. This chapter delineates instances where the AHA writing group developed recommendations that are significantly stronger or weaker than the ILCOR statements. In the online …

Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).

By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6

GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9

These evidence profile tables were then used to create a …

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Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.

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European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care.

Objectives
To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy.

/pdf/prognostication-in-comatose-survivors-of-cardiac-arrest-an-1g3vu344lg.pdf

Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine.

Objective:To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.Design:Prospective study.Setting:University hospital intensive care unit.Patients:Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardi

http://www.gicu.sgul.ac.uk/teaching/resources/mild-therapeutic-hypothermia-post-cardiac-arrest/seminal-papers-in-therapeutic-hypothermia-1/files/EEG_postROSC_CCM2009.pdf

Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity.

The invention relates to a method and apparatus for assessing the reactivity observable in a certain physiological signal, especially the EEG signal, of a comatose subject. In order to obtain an objective and a reliable measure of the reactivity automatically and without the presence of a trained EEG specialist, a time reference corresponding to a stimulus is detected and the physiological signal data obtained from the subject is aligned with the time reference. Two sets of values are determined for a measure indicative of the amount of irregularity in the physiological signal data, both sets including at least one value of the said measure and having defined positions with respect to the time reference in time domain. Based on the two sets, the apparatus determines whether reactivity is present in the physiological signal data.

Measurement of EEG reactivity

Bestimmung der Reaktivität mittels EEG Analyse

Die
Erfindung bezieht sich auf ein Verfahren und Gerat zur
Einschatzung der Reaktivitat, die in einem bestimmten
physiologischen Signal, insbesondere dem EEG-Signal, einer komatosen
Testperson (100) beobachtet werden kann. Um ein objektives und verlassliches Mas der
Reaktivitat automatisch und ohne das Zugegensein eines
ausgebildeten EEG-Spezialisten zu erhalten, wird ein gultiges
Signalmodell fur ein EEG-Signal konstruiert (12), welches
von der Testperson gewonnen wurde. Die Zeitreferenz, die einem Reiz
entspricht, wird angewendet, und es werden weitere Signaldaten von
der Zeitserie erfasst (14), wobei die weiteren Signaldaten der Zeitreferenz nachfolgen.
Durch die Anwendung der weiteren Signaldaten wird mittels des Verfahrens uberpruft
(15), ob das Signalmodell auch nach dem Reiz ein gultiges
Signalmodell fur das EEG-Signal bleibt, und es wird auf
der Grundlage der Uberprufung angezeigt (17),
ob in dem physiologischen Signal Reaktivitat vorhanden
ist.

Messung der EEG-Reaktivität

Die Erfindung bezieht sich auf ein Verfahren und Gerat zur Einschatzung der Reaktivitat, die in einem bestimmten physiologischen Signal, insbesondere dem EEG-Signal, einer komatosen Testperson (100) beobachtet werden kann. Um ein objektives und verlassliches Mas der Reaktivitat automatisch und ohne das Zugegensein eines ausgebildeten EEG-Spezialisten zu erhalten, wird ein gultiges Signalmodell fur ein EEG-Signal konstruiert (12), welches von der Testperson gewonnen wurde. Die Zeitreferenz, die einem Reiz entspricht, wird angewendet, und es werden weitere Signaldaten von der Zeitserie erfasst (14), wobei die weiteren Signaldaten der Zeitreferenz nachfolgen. Durch die Anwendung der weiteren Signaldaten wird mittels des Verfahrens uberpruft (15), ob das Signalmodell auch nach dem Reiz ein gultiges Signalmodell fur das EEG-Signal bleibt, und es wird auf der Grundlage der Uberprufung angezeigt (17), ob in dem physiologischen Signal Reaktivitat vorhanden ist.

Tapani Salmi

Papers

Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity.

Measurement of EEG reactivity

Bestimmung der Reaktivität mittels EEG Analyse

Messung der EEG-Reaktivität

Measuring the EEG reactivity