ILCOR Statement on Treatment Recommendations in CPR and Emergency Cardiovascular Care

The International Liaison Committee on Resuscitation (ILCOR) has issued its 2022 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) statement, as reported in Circulation.

The sixth annual summary addresses ILCOR task force analyses of recently published evidence regarding resuscitation. The updated review covers 21 topics that underwent a systematic review by 6 task forces: Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid task forces.

The task forces developed consensus treatment recommendations after assessing the quality of the evidence with use of the Grading of Recommendations Assessment, Development, and Evaluation criteria.

Recommendations from the Basic Life Support task force include advising against the routine use of passive ventilation techniques during conventional CPR (weak recommendation, very low-certainty evidence). The task force also recommends that preshock and postshock pauses in chest compressions be as short as possible (weak recommendation, very low-certainty evidence) and that the CPR fraction during cardiac arrest be as high as possible and 60% or more (weak recommendation, very low-certainty evidence). In addition, the Basic Life Support task force also suggests that providers administer resuscitation at the scene in place of ambulance transport with ongoing resuscitation unless there is an indication to justify transport (weak recommendation, very low-certainty evidence).

The Advanced Life Support task force suggests actively preventing fever with a temperature goal of 37.5°C or less in patients who are comatose after return of spontaneous circulation (ROSC) from cardiac arrest (weak recommendation, low-certainty evidence). It also recommends against routine use of prehospital cooling with rapid infusion of large volumes of cold intravenous fluid immediately following ROSC (strong recommendation, moderate-certainty evidence) and advises against routine use of point-of-care ultrasound during CPR to diagnose reversible causes of cardiac arrest (weak recommendation, very low-certainty evidence).

The Pediatric Life Support task force recommends that lay rescuers use an automated external defibrillator (AED) for all children aged older than 1 year with nontraumatic out-of-hospital cardiac arrest (OHCA) (weak recommendation, very low-certainty evidence) and cannot make a recommendation for or against the use of an AED by lay rescuers for patients aged younger than 1 year with nontraumatic OHCA.

For late preterm and term newborn infants (≥34 weeks’ gestation), the Neonatal Life Support task force recommends use of room temperatures of 23ºC vs 20ºC at birth to maintain normal temperature (weak recommendation, very low-certainty evidence). For late preterm and term newborn infants (≥34 weeks’ gestation) with a low risk of resuscitation, the task force recommends use of skin-to-skin care with a parent immediately after birth instead of no skin-to-skin care to maintain normal temperature (weak recommendation, very low-certainty evidence).

The Education, Implementation, and Teams task force advises against the use of any available pre-arrest prediction rule as the only reason not to resuscitate an adult patient with in-hospital cardiac arrest (strong recommendation, very low-certainty evidence). It also recommends basic life support training for likely rescuers of patients with a high risk of OHCA (strong recommendation, low- to moderate-certainty evidence), as well as a blended-learning approach for life support training when resources and accessibility allow its implementation (strong recommendation, very low-certainty evidence).

The First Aid task force recommends use of the recovery position when providing first aid to a patient who has a decreased level of responsiveness of nontraumatic origin and does not need immediate resuscitative interventions (weak recommendation, very low-certainty evidence).

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.