Slide 1

Guidelines for Cardiac Care Robert E. OConnor, M.D., MPH From Evidence to EMS Practice: Building the National Model The Kellogg Conference Hotel, Washington, DC September 4-5, 2008 Slide 2 ILCOR Science and Guidelne Update Councils Develop Guidelines and Revise Materials Councils Rollout Training ILCOR Continuous International Science Review Search, Review and Debate Scientific Evidence, Manage Conflict of Interest, Summarize consensus treatment recommendations, identify gaps in knowledge, explore controversies Slide 3 INTERNATIONAL EVIDENCE-BASED CPR, ECC Implementation Base guidelines based on the BEST science Collaborate with worldwide experts Evaluate evidence objectively Avoid biases, disclose conflicts of interest Slide 4 Generalizable knowledge for better clinical practice and healthcare knowledge from research (research evidence)knowledge from research (research evidence) knowledge from the analysis of routinely collected and audit data (statistics)knowledge from the analysis of routinely collected and audit data (statistics) knowledge from the experience of providers and patients (know how)knowledge from the experience of providers and patients (know how) Slide 5 Slide 6 From Question to Guideline Task Force Identifies Questions Assign Worksheet Authors Worksheet Authors Review Extranet Searches literature Endnote, Pubmed, Embase, Cochrane Identifies and reads pertinent articles Completes worksheet Worksheet Review Task Force Co-Chairs Worksheet Gurus Worksheet submission Question Worksheet Accepted Worksheet Public Comment International 2010 CPR Conference Worksheets presented and discussed Consensus reached ILCOR Consensus On Science 1 2 3 4 Guideline recommendation Slide 7 Conflict of Interest A specific conflict of interest form will need to be completed electronically, and updated on a regular basis, as part of the registration process.A specific conflict of interest form will need to be completed electronically, and updated on a regular basis, as part of the registration process. In addition to this, to facilitate the review process, a brief declaration regarding any relevant conflicts is required for each worksheet on behalf of all authors.In addition to this, to facilitate the review process, a brief declaration regarding any relevant conflicts is required for each worksheet on behalf of all authors. Slide 8 Asking the Question: the PICO format Slide 9 Databases to be searched The Cochrane Library (for Systematic Reviews, DARE, and the Central register of Controlled Trials)The Cochrane Library (for Systematic Reviews, DARE, and the Central register of Controlled Trials) Medline (eg. via PubMed, OVID or Scopus)Medline (eg. via PubMed, OVID or Scopus) EmbaseEmbase the AHA Endnote databasethe AHA Endnote database Secondary SearchesSecondary Searches Slide 10 Levels of Evidence for Therapeutic Interventions 2010 LOE 1: Randomised Controlled Trials (or meta- analyses of RCTs)LOE 1: Randomised Controlled Trials (or meta- analyses of RCTs) LOE 2: Studies using concurrent controls without true randomisation (eg. pseudo- randomised) (or meta-analyses of such studies)LOE 2: Studies using concurrent controls without true randomisation (eg. pseudo- randomised) (or meta-analyses of such studies) LOE 3: Studies using retrospective controlsLOE 3: Studies using retrospective controls LOE 4: Studies without a control group (eg. case series)LOE 4: Studies without a control group (eg. case series) LOE 5: Studies not directly related to the specific patient/population (eg. different patient/population, animal models, mechanical models etc.)LOE 5: Studies not directly related to the specific patient/population (eg. different patient/population, animal models, mechanical models etc.) Slide 11 Slide 12 Quality of Study 2008 Good studies would be expected to have most/all of the quality items suggested to assess the type of study (see below).Good studies would be expected to have most/all of the quality items suggested to assess the type of study (see below). Fair studies would be expected to have some of the quality items suggested to assess the type of study (see below).Fair studies would be expected to have some of the quality items suggested to assess the type of study (see below). Poor studies would be expected to have few of the quality items suggested to assess the type of study (see below), but to be of sufficient vale to include for further review.Poor studies would be expected to have few of the quality items suggested to assess the type of study (see below), but to be of sufficient vale to include for further review. Slide 13 Slide 14 The choice of outcome designations include: A = Return of spontaneous circulation B = Survival of event C = Survival to hospital discharge D = Intact neurological survival E = Other endpoint Slide 15 Neutral/opposing evidence table denotes key article(s) Slide 16 Important Details from c2005 Conflict of Interest Ad Hoc TeamConflict of Interest Ad Hoc Team Most controversial topics sessionMost controversial topics session Lockbox ConceptLockbox Concept Collaborating AgenciesCollaborating Agencies Posting of Worksheets to Website:Posting of Worksheets to Website: Talley: >280 Topics and >400 Worksheet AuthorsTalley: >280 Topics and >400 Worksheet Authors 40% of >300 International scientists were international40% of >300 International scientists were international WWW.C2005.ORG Slide 17 Lockbox Animated ILCOR Timeline toward 2010 (12March 2007) ILCOR March 2007 South Africa Councils: Guidelines and Training Materials Rollouts 2011 ILCOR/ ReSS Orlando Nov 2007 ILCOR SIGNOFF New York May 2010 2010 Science Publications December ILCOR Evidence Evaluation Posted December 2009 Jan 2008 Jan 2009 Jan 2010 Jan 2011 ERC/ ILCOR Ghent May 2008 ILCOR/ ReSS New Orleans Nov 2008 ILCOR/ ???? April or May 2009 ILCOR/ ReSS Chicago Nov 2009 International Consensus Conference February, 2005 (Dallas) Slide 18 Slide 19 Topic Domains - columns of science Provider Level EMT - P EMT - I EMT - B Interfacility Transport First Responder Slide 20 Resuscitation Council of Asia Slide 21 Do the right things... andDo the things right!