Future Vision for ILCOR and Its Role in the Global Resuscitation Community
2018; Lippincott Williams & Wilkins; Volume: 138; Issue: 11 Linguagem: Inglês
10.1161/circulationaha.118.029786
ISSN1524-4539
AutoresRobert W. Neumar, Gavin D. Perkins,
Tópico(s)Respiratory Support and Mechanisms
ResumoHomeCirculationVol. 138, No. 11Future Vision for ILCOR and Its Role in the Global Resuscitation Community Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBFuture Vision for ILCOR and Its Role in the Global Resuscitation Community Robert W. Neumar, MD, PhD and Gavin D. Perkins, MBChB, MD Robert W. NeumarRobert W. Neumar Robert W. Neumar, MD, PhD, Department of Emergency Medicine, University of Michigan Health System, 1500 East Medical Center Drive, Room TC B1220, Ann Arbor, MI 48109. Email E-mail Address: [email protected] Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor (R.W.N.). and Gavin D. PerkinsGavin D. Perkins Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, United Kingdom (G.D.P.). Originally published10 Sep 2018https://doi.org/10.1161/CIRCULATIONAHA.118.029786Circulation. 2018;138:1085–1087The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to work collaboratively across international boundaries to synthesize scientific evidence and develop consensus on optimal resuscitation practice.1 In doing so, ILCOR aimed to reduce variation and ensure that victims of sudden cardiac death receive the most effective, evidence-based treatments. The resulting international consensus on science with treatment recommendations form a common platform for resuscitation councils around the world to develop local treatment guidelines (Figure).Download figureDownload PowerPointFigure. Conceptual model showing ILCOR's vision and values in relation to its core mission "to promote, disseminate and advocate international implementation of evidence-informed resuscitation and first aid, using transparent evaluation and consensus summary of scientific data." ILCOR's continuous evidence evaluation process pulls together the latest scientific evidence for review and scrutiny by international tasks forces specializing in basic life support and automated external defibrillation, advanced life support, pediatric and neonatal life support, and first aid. The resulting consensus on science with treatment recommendations (CoSTR) are used by resuscitation councils around the world to inform clinical practice guidelines. The ILCOR dashboard of registries seeks to capture the effect of the global efforts to save more lives through resuscitation. ILCOR indicates International Liaison Committee on Resuscitation.Decades since the creation of ILCOR, cardiac arrest remains a major international public health problem accounting for an estimated 15% to 20% of all deaths.2 The incidence of emergency medical services–assessed out-of-hospital cardiac arrest in various continents ranges from 53 to 112 per 100 000/y, with survival rates rarely exceeding 10%.2 Despite this significant disease burden, only 92 cardiac arrest randomized clinical trials were published in the 20 years between 1995 and 2014.3 However, the pipeline moving forward is more promising with 140 interventional cardiac arrest clinical trials registered in ClinicalTrials.gov as of March 1, 2018. To further catalyze resuscitation research, ILCOR has prioritized knowledge gaps in the field.4But challenges remain for ILCOR. In parallel with the rapid growth in clinical resuscitation science is the demand for rapid translation of these findings into clinical practice. Social media platforms such as blogs, podcasts, and electronic journal clubs have enabled disruptive innovation in this arena. However, this accelerated method of knowledge translation creates an emerging risk that treatment strategies will be prematurely adopted or discontinued based on the misinterpretation of clinical trial results. A further challenge is that the greatest burden of cardiac arrest is in regions underrepresented in ILCOR's organizational structure. Last, our vision of "saving more lives globally through resuscitation" cannot be realized without measuring the effect of new treatment recommendations and guidelines on patient outcome across the globe.ILCOR is responding to these challenges by:Transitioning from periodic to continuous evidence evaluation: For the past 2 decades, ILCOR has published the Consensus on Science with Treatment Recommendations (CoSTR) in 5-year cycles. After the publication of the 2015 CoSTR, ILCOR transitioned to a continuous evidence evaluation process that will now regularly generate new and updated CoSTRs based on structured PICOST questions (population, intervention, comparison, outcome, situation, and type of evidence). ILCOR Task Forces, supported by domain leads, expert systematic reviewers, and knowledge synthesis units, will prioritize the generation of new or updated CoSTRs based on emerging science and potential effect on patient outcomes. New and updated CoSTRs will be published on the ILCOR website (www.ilcor.org), and as an annual summary article in the journals Circulation and Resuscitation. The first annual update was published in 2017.5 ILCOR member councils will use new and updated CoSTRs to update their guidelines and educational materials when appropriate. With the expanding science database and complexity of the continuous evaluation process, ILCOR will need to maximize the efficiency of its processes to translate new science to the bedside as rapidly as possible.Responding to the disruptive innovation of social media: Social media is rapidly transforming medical education and disrupting the traditional guideline-based knowledge translation pathway. Social media can rapidly reach large groups of engaged medical providers with the opportunity for real-time international electronic debate of new science immediately after publication. However, the potential benefit of rapid translation must be balanced by the risk. Misinterpreting the effect of a single study on the body of knowledge can lead to premature adoption of new therapies or discarding of existing therapies. Moreover, within the complex systems of care for in-hospital and out-of-hospital cardiac arrest, changes in patient management strategies must be coordinated across all provider families involved. The time and expense of systematic organizational change is often more rate limiting than the traditional guideline development process. ILCOR remains convinced that rigorous structured evidence evaluation with consensus interpretation by international experts remains the gold standard to drive knowledge translation. The move to a streamlined, continuous, evidence evaluation process with greater stakeholder involvement through the use of social media platforms aims to address these challenges.Expanding geographic distribution of membership and engaging new collaborators:To align with our vision, we need to progressively and strategically expand our geographic reach. ILCOR will pursue this goal by facilitating the development of regional resuscitation councils in parts of the world where ILCOR representation is lacking. In addition, ILCOR is seeking to formally engage collaborative partners whose work is complimentary to the mission of ILCOR. Examples include the World Health Organization and International Federation of Red Cross and Red Crescent. Another new ILCOR initiative to increase global public engagement is the ILCOR World Restart a Heart program. The primary goal of ILCOR World Restart a Heart is to increase cardiac arrest awareness and bystander cardiopulmonary resuscitation rates in all countries worldwide. The first annual ILCOR World Restart a Heart Day will October 16, 2018.Creating a global dashboard of cardiac arrest registries: ILCOR set the standard for collecting and reporting clinical cardiac arrest data by creating the first Utstein-style reporting guidelines. National and regional cardiac arrest registries are now well established, and many continue to emerge. As part of ILCOR's global quality improvement mission, the organization will create a global dashboard of cardiac arrest registries to collect and report annual data voluntarily supplied by national and regional cardiac arrest registries. This initiative will provide, for the first time, a global snapshot of our cardiac arrest systems of care and enable continuous monitoring of the effect that ILCOR, its member councils, collaborating partners, governmental entities, and local providers are having on cardiac arrest outcomes worldwide.In summary, ILCOR has many reasons to celebrate the accomplishments of its first 25 years, but much work remains to be done. As an organization, ILCOR is adapting to the rapidly evolving field of resuscitation science, disruptive innovations in knowledge translation, demand for evidence-based clinical practice, and the need to address global disparities in medical care. Through this evolution, we will remain focused on our vision of saving more lives globally through resuscitation.DisclosuresDr Neumar is a co-chair of ILCOR and the ILCOR Liaison to the American Heart Association. Dr Perkins is a co-chair of ILCOR and a board director for the European Resuscitation Council.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circRobert W. Neumar, MD, PhD, Department of Emergency Medicine, University of Michigan Health System, 1500 East Medical Center Drive, Room TC B1220, Ann Arbor, MI 48109. Email [email protected]eduReferences1. 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Holmén J, Herlitz J, Ricksten S, Strömsöe A, Hagberg E, Axelsson C and Rawshani A (2020) Shortening Ambulance Response Time Increases Survival in Out‐of‐Hospital Cardiac Arrest, Journal of the American Heart Association, 9:21, Online publication date: 3-Nov-2020. September 11, 2018Vol 138, Issue 11 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.029786PMID: 30354385 Originally publishedSeptember 10, 2018 Keywordsresuscitationguidelinecardiopulmonary resuscitationheart arrestdeath, sudden, cardiacPDF download Advertisement SubjectsCardiopulmonary ArrestCardiopulmonary Resuscitation and Emergency Cardiac CareSudden Cardiac DeathVentricular Fibrillation
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