Podcast
Questions and Answers
The European Resuscitation Council's (ERC) primary objective is to:
The European Resuscitation Council's (ERC) primary objective is to:
- Promote research in cardiology.
- Preserve human life by ensuring high-quality resuscitation is available. (correct)
- Standardize first aid training globally.
- Reduce the cost of resuscitation equipment.
In what year were the first European Resuscitation Council (ERC) guidelines for basic and advanced life support presented?
In what year were the first European Resuscitation Council (ERC) guidelines for basic and advanced life support presented?
- 2000
- 1992 (correct)
- 1994
- 2005
What does ILCOR, which informs the ERC guidelines, stand for?
What does ILCOR, which informs the ERC guidelines, stand for?
- Inter-continental Life and Cardiac Organisation for Resuscitation
- Inter-European Life-support Council on Resuscitation
- International Liaison Committee on Resuscitation (correct)
- International Life-saving Committee on Resuscitation
Which of the following best describes the evolution of ILCOR's evidence evaluation process?
Which of the following best describes the evolution of ILCOR's evidence evaluation process?
Which of the following is NOT a topic covered in the 2021 European Resuscitation Council Guidelines?
Which of the following is NOT a topic covered in the 2021 European Resuscitation Council Guidelines?
What is the minimum percentage of writing group members for the ERC guidelines required to be free of commercial conflicts of interest?
What is the minimum percentage of writing group members for the ERC guidelines required to be free of commercial conflicts of interest?
What is the primary method for arriving at recommendations in the ERC guidelines when no relevant ILCOR treatment recommendation exists?
What is the primary method for arriving at recommendations in the ERC guidelines when no relevant ILCOR treatment recommendation exists?
What is the quorum required for conducting writing group business and reaching consensus within the ERC guideline development process?
What is the quorum required for conducting writing group business and reaching consensus within the ERC guideline development process?
Which of the following is NOT one of the three styles of evidence evaluation undertaken by ILCOR since 2015?
Which of the following is NOT one of the three styles of evidence evaluation undertaken by ILCOR since 2015?
What is the main purpose of 'scoping reviews' in the context of ERC guideline development?
What is the main purpose of 'scoping reviews' in the context of ERC guideline development?
What is the purpose of 'evidence updates' within the ILCOR evidence evaluation process?
What is the purpose of 'evidence updates' within the ILCOR evidence evaluation process?
According to GRADE certainty levels, 'moderate certainty' implies:
According to GRADE certainty levels, 'moderate certainty' implies:
A 'strong recommendation' in ILCOR COSTRs indicates that:
A 'strong recommendation' in ILCOR COSTRs indicates that:
What is the typical term used in ILCOR recommendations to indicate a 'weak recommendation'?
What is the typical term used in ILCOR recommendations to indicate a 'weak recommendation'?
What was the primary method used for stakeholder consultation on the ERC guidelines?
What was the primary method used for stakeholder consultation on the ERC guidelines?
How often does the ERC aim to produce routine updates to its guidelines and course materials?
How often does the ERC aim to produce routine updates to its guidelines and course materials?
What is the official journal of the European Resuscitation Council (ERC) where guidelines and updates are typically published?
What is the official journal of the European Resuscitation Council (ERC) where guidelines and updates are typically published?
During the initial COVID-19 wave, what was a commonly reported change in the cause of out-of-hospital cardiac arrests?
During the initial COVID-19 wave, what was a commonly reported change in the cause of out-of-hospital cardiac arrests?
Which of the following was NOT consistently observed regarding bystander CPR rates during the COVID-19 pandemic?
Which of the following was NOT consistently observed regarding bystander CPR rates during the COVID-19 pandemic?
What is the primary focus of the ERC COVID-19 guidelines?
What is the primary focus of the ERC COVID-19 guidelines?
According to the epidemiology section of the 2021 ERC guidelines, approximately what percentage of European countries have out-of-hospital cardiac arrest registries?
According to the epidemiology section of the 2021 ERC guidelines, approximately what percentage of European countries have out-of-hospital cardiac arrest registries?
What is the average survival rate to hospital discharge for out-of-hospital cardiac arrest in Europe?
What is the average survival rate to hospital discharge for out-of-hospital cardiac arrest in Europe?
In European countries where withdrawal of life-sustaining treatment (WLST) is routinely practiced, what is the typical neurological outcome for survivors of in-hospital cardiac arrest?
In European countries where withdrawal of life-sustaining treatment (WLST) is routinely practiced, what is the typical neurological outcome for survivors of in-hospital cardiac arrest?
What is a key recommendation regarding population-based registries for cardiac arrest from the ERC guidelines?
What is a key recommendation regarding population-based registries for cardiac arrest from the ERC guidelines?
The 'chain of survival' concept emphasizes:
The 'chain of survival' concept emphasizes:
Which technology is highly encouraged by the ERC guidelines to improve bystander CPR rates and response times?
Which technology is highly encouraged by the ERC guidelines to improve bystander CPR rates and response times?
What is the recommended approach for dispatch-assisted CPR instructions regarding chest compression-only CPR compared to standard CPR?
What is the recommended approach for dispatch-assisted CPR instructions regarding chest compression-only CPR compared to standard CPR?
What is the recommended compression depth for high-quality chest compressions in adult basic life support?
What is the recommended compression depth for high-quality chest compressions in adult basic life support?
If a rescuer is unable to perform rescue breaths during adult basic life support, what is the recommended alternative?
If a rescuer is unable to perform rescue breaths during adult basic life support, what is the recommended alternative?
What is the recommended initial action when an Automated External Defibrillator (AED) arrives at the scene of a cardiac arrest?
What is the recommended initial action when an Automated External Defibrillator (AED) arrives at the scene of a cardiac arrest?
What is the recommended course of action if an AED indicates 'no shock advised'?
What is the recommended course of action if an AED indicates 'no shock advised'?
In the BLS algorithm, what is the compression-to-ventilation ratio for adult CPR?
In the BLS algorithm, what is the compression-to-ventilation ratio for adult CPR?
What is the first action to take when encountering a person suspected of having a foreign body airway obstruction (FBAO) who is conscious?
What is the first action to take when encountering a person suspected of having a foreign body airway obstruction (FBAO) who is conscious?
According to the ALS guidelines, when is adrenaline recommended for use in cardiac arrest with a non-shockable rhythm?
According to the ALS guidelines, when is adrenaline recommended for use in cardiac arrest with a non-shockable rhythm?
What is the expert consensus for the minimum success rate for tracheal intubation within two attempts for rescuers who choose to use this advanced airway technique?
What is the expert consensus for the minimum success rate for tracheal intubation within two attempts for rescuers who choose to use this advanced airway technique?
When is amiodarone recommended in the ALS algorithm for shockable cardiac arrest rhythms?
When is amiodarone recommended in the ALS algorithm for shockable cardiac arrest rhythms?
In cases of refractory ventricular fibrillation (VF), what alternative defibrillation pad position might be considered?
In cases of refractory ventricular fibrillation (VF), what alternative defibrillation pad position might be considered?
What is the recommended ventilation rate once an advanced airway (tracheal tube or supraglottic airway) is placed during ALS?
What is the recommended ventilation rate once an advanced airway (tracheal tube or supraglottic airway) is placed during ALS?
In which type of cardiac arrest is thrombolytic drug therapy specifically mentioned as a consideration in the ERC guidelines?
In which type of cardiac arrest is thrombolytic drug therapy specifically mentioned as a consideration in the ERC guidelines?
What is the recommended duration of CPR to consider after administering thrombolytic drugs in cardiac arrest?
What is the recommended duration of CPR to consider after administering thrombolytic drugs in cardiac arrest?
In peri-arrest tachycardias, when is electrical cardioversion the preferred treatment?
In peri-arrest tachycardias, when is electrical cardioversion the preferred treatment?
For atrial flutter and paroxysmal supraventricular tachycardia in unstable patients, what is the recommended initial shock energy?
For atrial flutter and paroxysmal supraventricular tachycardia in unstable patients, what is the recommended initial shock energy?
In bradycardia accompanied by adverse signs, what is the initial dose of atropine recommended?
In bradycardia accompanied by adverse signs, what is the initial dose of atropine recommended?
Which drug might be considered for bradycardia caused by inferior myocardial infarction, cardiac transplant, or spinal cord injury?
Which drug might be considered for bradycardia caused by inferior myocardial infarction, cardiac transplant, or spinal cord injury?
In managing hypothermia-induced cardiac arrest, at what core temperature is it recommended to delay further defibrillation attempts if ventricular fibrillation (VF) persists after three shocks?
In managing hypothermia-induced cardiac arrest, at what core temperature is it recommended to delay further defibrillation attempts if ventricular fibrillation (VF) persists after three shocks?
In avalanche rescue, what is considered the most likely cause of cardiac arrest and thus the priority intervention?
In avalanche rescue, what is considered the most likely cause of cardiac arrest and thus the priority intervention?
For heat stroke, at what rate of cooling is considered safe and desirable in exertional heat stroke?
For heat stroke, at what rate of cooling is considered safe and desirable in exertional heat stroke?
In cardiac arrest due to pulmonary embolism, low ETCO2 readings during CPR may:
In cardiac arrest due to pulmonary embolism, low ETCO2 readings during CPR may:
In the context of cardiac arrest in the operating room (OR), what type of chest compression is mentioned as an effective alternative to closed chest compression?
In the context of cardiac arrest in the operating room (OR), what type of chest compression is mentioned as an effective alternative to closed chest compression?
According to the ERC guidelines, what overarching principle should guide the decision to translate new ILCOR CoSTRs into guideline and educational updates?
According to the ERC guidelines, what overarching principle should guide the decision to translate new ILCOR CoSTRs into guideline and educational updates?
What is the recommended chest compression rate for adult CPR, according to the BLS guidelines?
What is the recommended chest compression rate for adult CPR, according to the BLS guidelines?
In the context of post-resuscitation care, which tool should be integrated with emergency care treatment plans to increase clarity of treatment goals?
In the context of post-resuscitation care, which tool should be integrated with emergency care treatment plans to increase clarity of treatment goals?
According to the ERC guidelines, after failed defibrillation attempts and in the context of refractory VF, what alternative defibrillation pad position may be considered?
According to the ERC guidelines, after failed defibrillation attempts and in the context of refractory VF, what alternative defibrillation pad position may be considered?
What is the suggested first action a healthcare provider should take for a patient presenting with syncope, palpitations and dizziness?
What is the suggested first action a healthcare provider should take for a patient presenting with syncope, palpitations and dizziness?
In post-cardiac arrest care, what is the recommendation for temperature management according to the ERC?
In post-cardiac arrest care, what is the recommendation for temperature management according to the ERC?
In avalanche rescue, what intervention is the first priority?
In avalanche rescue, what intervention is the first priority?
During the administration of chest compressions, 'hands-on' defibrillation poses what risk?
During the administration of chest compressions, 'hands-on' defibrillation poses what risk?
What action should be performed after delivering an initial shock using an AED?
What action should be performed after delivering an initial shock using an AED?
According to the ERC guidelines, what is a critical component of the initial assessment of a person with a suspected foreign body airway obstruction (FBAO)?
According to the ERC guidelines, what is a critical component of the initial assessment of a person with a suspected foreign body airway obstruction (FBAO)?
In which specific situation should IV fluids be administered during cardiac arrest?
In which specific situation should IV fluids be administered during cardiac arrest?
According to the guidelines, after providing initial care for burns, what is the next step?
According to the guidelines, after providing initial care for burns, what is the next step?
Following the European Resuscitation Council (ERC) guidelines, which of these actions is emphasized to improve bystander CPR rates and response times?
Following the European Resuscitation Council (ERC) guidelines, which of these actions is emphasized to improve bystander CPR rates and response times?
In managing peri-arrest arrythmias, which condition requires anaesthesia or sedation before synchronised cardioversion?
In managing peri-arrest arrythmias, which condition requires anaesthesia or sedation before synchronised cardioversion?
You are called to attend to a person who has fallen in the snow. They are unresponsive with a thermometer reading of 29 degrees Celcius. They have had three unsuccessful defibrillation attempts. What is the next best step?
You are called to attend to a person who has fallen in the snow. They are unresponsive with a thermometer reading of 29 degrees Celcius. They have had three unsuccessful defibrillation attempts. What is the next best step?
What is the immediate next best step if faced with a patient who may have a neck injury?
What is the immediate next best step if faced with a patient who may have a neck injury?
If an adult patient does not respond to initial treatment with atropine, what should be considered next for bradycardia?
If an adult patient does not respond to initial treatment with atropine, what should be considered next for bradycardia?
During manual defibrillation, how should the pads be placed on a patient with an implanted device?
During manual defibrillation, how should the pads be placed on a patient with an implanted device?
According to the ERC guidelines, what is the suggested weight to volume ratio for crystalloid solution administration for those in shock?
According to the ERC guidelines, what is the suggested weight to volume ratio for crystalloid solution administration for those in shock?
Following current ERC guidance, which type of layperson is encouraged to perform CPR and should be free from concerns of harming victims not in cardiac arrest?
Following current ERC guidance, which type of layperson is encouraged to perform CPR and should be free from concerns of harming victims not in cardiac arrest?
In regards to tidal volume and lung ventilation once a tracheal tube is in place, what is the current guideline?
In regards to tidal volume and lung ventilation once a tracheal tube is in place, what is the current guideline?
A person is suspected of having a stroke but conscious nonetheless. What is the first action to take?
A person is suspected of having a stroke but conscious nonetheless. What is the first action to take?
In what situation is the action of chest compressions contraindicated?
In what situation is the action of chest compressions contraindicated?
A patient who has overdosed on an unknown drug has now gone into cardiac arrest. What treatment is essential to provide?
A patient who has overdosed on an unknown drug has now gone into cardiac arrest. What treatment is essential to provide?
Flashcards
ERC objective
ERC objective
To preserve human life by making high-quality resuscitation available to all.
ILCOR's goal
ILCOR's goal
To save more lives globally through resuscitation.
Clinical practice guidelines
Clinical practice guidelines
Healthcare systems rely increasingly on them.
ILCOR Evidence Evaluation process
ILCOR Evidence Evaluation process
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Chain of survival
Chain of survival
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KIDS SAVE LIVES
KIDS SAVE LIVES
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Dispatch-assisted CPR
Dispatch-assisted CPR
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How to Recognize Cardiac Arrest
How to Recognize Cardiac Arrest
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Dispatch-assisted chest compression
Dispatch-assisted chest compression
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What Does CHECK CALL COMPRESS represent?
What Does CHECK CALL COMPRESS represent?
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High-quality chest compressions
High-quality chest compressions
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ERC COVID-19 guidelines
ERC COVID-19 guidelines
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How to alert the emergency services
How to alert the emergency services
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Rescue breaths
Rescue breaths
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Advanced airway
Advanced airway
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Thrombolytic drugs administration
Thrombolytic drugs administration
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Electrical conversion
Electrical conversion
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Renal Replacement therapy
Renal Replacement therapy
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For Ventricular tachycardia with a pulse
For Ventricular tachycardia with a pulse
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Hypoxia after cardiac arrest
Hypoxia after cardiac arrest
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Avalanche Rescue
Avalanche Rescue
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Study Notes
2021 European Resuscitation Council Guidelines: Executive Summary
- The 2021 ERC Guidelines present the most current evidence-based guidelines for resuscitation practice throughout Europe.
Guidelines Scope
- Epidemiology of cardiac arrest
- Role of systems in saving lives
- Adult basic and advanced life support
- Resuscitation in special circumstances
- Post resuscitation care, first aid, neonatal and pediatric life support
- Focus on ethics and education.
Objective
- Preserve human life
- Make high quality resuscitation available to all through up-to-date, evidence-based European guidelines for cardiac arrest prevention and treatment, as well as other life-threatening emergencies
History
- First ERC guidelines were presented in Brighton in 1992, covering basic and advanced life support.
- Guidelines for Paediatric Life Support (PLS) and peri-arrest arrhythmias were then followed.
- Guidelines for airway and ventilation in resuscitation were introduced in Seville in 1996.
- Updated guidelines appeared at the 4th ERC Scientific Congress in Copenhagen (1998).
- 2000: International resuscitation guidelines were produced with ILCOR collaboration, which the ERC summarised in 2001.
- ERC produced the guidelines every five years following this, in 2005, 2010, and 2015, with annual updates linked to ILCOR's Consensus on Science and Treatment Recommendations from 2017 onward
- Guidelines addressing resuscitation during the 2019 coronavirus disease (COVID-19) were introduced in 2020.
Development
- Healthcare systems are increasingly relying on these evidence-based guidelines, and they have also grown in influence
- Improving norms and transparency in guideline development.
Standards
- The Institute of Medicine established clinical practice guideline quality standards in 2011 which was shortly followed.
- The ERC Guidelines were then developed by the Guidelines International Network, adhering to their principles for guideline development.
Process
- Guidance on panel composition, decision-making, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding were taken into account.
- The writing group chairs and members were selected on the grounds of their credibility as prominent resuscitation scientists, clinicians, and methodologists.
- Ensure a balance in terms of professions (doctors, nurses, paramedics), gender, early career specialists, ethnicity, Europe-wide geographic representation and representation from key stakeholders
Writing Group Member Roles
- Providing clinical and scientific knowledge to the guideline's writing process
- Engaging actively in the majority of writing group conference calls
- Conducting thorough literature reviews on specified topics upon guideline request
- Presenting review results and facilitating group discussions on particular topics
- Refining and developing clinical practice algorithms and guidelines
- Meeting the International Committee of Medical Journal Editors' (ICMJE’s) authorship requirements
- Being ready to be held accountable in public about what the guidelines contain and encouraging their use
- Abiding by the ERC’s conflict of interest regulations.
Decision Making
- ERC standards are drawn from the recommendations of the International Liaison Committee on Resuscitation, or ILCOR
- In areas with no ILCOR treatment recommendations, expert consensus was achieved through working group review and debate of the evidence.
- Open, constructive discussions were ensured by the writing group chairs, allowing each member to express and argue their opinions.
- All group members had to approve each recommendation, and any failure to achieve consensus was noted in the recommendation's wording.
- At least 75% of the members of the writing group must be present to constitute a quorum for writing group business and consensus
- The ERC General Assembly received and approved the guidelines' scope and final version
Financial Support
- Business alliances support the ERC's overall activities, although the ERC guidelines are developed entirely without the influence of business partners.
Conflict of Interest
- Adhering to the ERC's COI policy
- Completing annual COI declarations that are reviewed by the Governance Committee, with conflict reports available on the ERC website
- Requiring the writing group chair, and at least 50% of the writing group members, to be free of commercial COIs.
- Allowing writing group members who have a COI to still participate in discussions relevant to that subject, but not to be involved in drafting or approving recommendations at the chair’s discretion
Figure 1
- Step-wise process for developing the ERC guidelines:
- Define Topics
- Appoint Writing Groups
- Develop Scope
- Consultation
- Identify Evidence
- Summary and Recommendations
- Consultation
- Publication
ILCOR
- The ERC is one of its founding members, and closely collaborates to achieve their goals.
- Key activities include systematic evidence evaluation and producing global science consensus with treatment recommendations.
- After switching to ongoing evidence assessment in 2017, ILCOR, which initially produced reports every five years, released the 2020 CoSTR, which incorporates 184 studies of resuscitation science
Evidence Assessment Styles
- ILCOR's systematic reviews
- Methodological principles coming from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the Institute of Medicine, and the Cochrane Collaboration
- Presented as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA.
- Supplementing systematic reviews with scoping reviews-performed internally or by members of the ERC writing groups in order to take a broader approach to the topic
- Evidence Updates are to address topics that had not been formally reviewed for a number of years and to identify if a formal review should be prompted
Information on Grading of Recommendations Assessment, Development and Evaluation (GRADE)
- High: Very confident that the true effect is near the estimate of the effect
- Moderate: Likely to have the true effect lie near the effect estimate and moderate confidence
- Low: Confidence is constrained and the true effect may be substantially different from the estimate, effect estimate is limited
- Very Low: With little certainty as the true result and limited confidence, It’s possible that the estimate varies significantly from the true impact
Main guideline areas:
- Systems in place for saving lives
- First aid including resuscitation
- Adult, pediatric and neonatal life support
- Conditions requiring specific treatment when patients need resuscitation
- Ethics
- Education
Council Network
- Guidelines are disseminated through network of 33 resuscitation councils
- Audience: lay people, first aiders, first respondents, members of the community health
- Staff, nurses and other members of ambulance and hospital staffs, trainers, lecturers as well as policy experts in the field of healthcare
- Settings: relevant in both community and in-hospital environments
COVID-19 Statistics
- 10 studies, including 35,379 participants, showed an increase in the incidence of out-of-hospital cardiac arrest during the initial COVID-19 wave
- Increased cardiac arrest was attributed to direct and indirect effects of COVID-19
Continuous Review
- These guidelines are continuously updated online as new evidence becomes accessible.
- The primary ERC Guidelines deal with resuscitation for those who are at low risk or confirmed to be negative for COVID-19.
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