Part 2: Evidence evaluation and management of conflicts of interest: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations☆,☆☆
Introduction
The international resuscitation community, under the guidance of the International Liaison Committee on Resuscitation (ILCOR), has continued its process to identify and summarize the published resuscitation science in the documents known as the ILCOR Consensus on Science with Treatment Recommendations (CoSTR). The accompanying articles represent the culmination of many years work, where a total of 250 evidence reviewers from 39 countries completed 165 systematic reviews on resuscitation related questions.
Section snippets
Process before 2015
The processes previously used by ILCOR in the development of their CoSTR were specifically tailored to the complex needs of resuscitation science. At the time that the evidence evaluation was undertaken for the 2010 publication, there were still no other processes which could deal with the complexity of literature that we need to evaluate: from randomized controlled trials to case series, and from mathematical models to animal studies. The 2010 evidence evaluation process required completion of
Improvements for the 2015 process
When developing the process to be adopted for the 2015 CoSTR, ILCOR made a commitment to use the best available methodological tools to conduct its evaluation of the published resuscitation literature. To this end, ILCOR agreed to perform systematic reviews based on the recommendations of the Institute of Medicine of the National Academies,4 and to use the methodological approach proposed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group.5
In
Why introduce the GRADE process?
The methodological approach proposed by the GRADE Working Group has been developed over the past decade by key health professionals, researchers, and guideline developers in an attempt to provide a consistent and transparent process for use in guideline development.6 It provides guidance for the rating of quality of evidence and the grading of strength of recommendations in health care. It is now widely used in the guideline development processes throughout the world including by organizations
The 2015 ILCOR evidence evaluation process
The 2015 ILCOR evidence evaluation followed a complex but systematic process. In general, the steps followed are consistent with those outlined by the Institute of Medicine.4 During the development of this process, a transition was made to a more complete online process, using a combination of existing and newly developed tools. The steps in the evidence review process are outlined in Table 1.
Lower levels of evidence
In many resuscitation scenarios, there are no RCTs or even good observational studies, so there is a need to explore other population groups. The GRADE process is very explicit about the allocation of quality of evidence to support the individual outcomes. Extrapolation of data from other patient groups (e.g., adult versus pediatric, cardiac arrest versus shock), mathematical models, and animal studies means that this evidence, irrespective of methodological quality, would be downgraded for at
Management of conflicts of interest throughout the CoSTR process
To ensure the integrity of the evidence evaluation and consensus on science development process, ILCOR followed its rigorous conflict of interest (COI) management policies at all times. A full description of these policies and their implementation can be found in Part 4 of the 2010 CoSTR.32, 33 All persons involved in any part of the process disclosed all commercial relationships and other potential conflicts, and in total, the AHA processed more than 1000 COI declarations. These disclosures
Summary
The process for evaluating the resuscitation science has evolved considerably over the past 2 decades. The current process, which incorporates the use of the GRADE methodology, culminated in the 2015 CoSTR publication, which in turn will inform the international resuscitation councils’ guideline development processes. Over the next few years, the process will continue to evolve as ILCOR moves toward a more continuous evaluation of the resuscitation science.
Disclosures
2015 CoSTR Part 2: Evidence evaluation: writing group disclosures.Empty Cell Employment Research grant Other research support Speakers’ bureau/honoraria Expert witness Ownership interest Consultant/advisory board Other Writing group member Peter T. Morley University of Melbourne None None None None None American Heart Association† None Eddy Lang University of Calgary None None None None None American Heart Association† None Richard Aickin Starship Children's Hospital None None None None None None None John E. Billi The University of Michigan
Acknowledgements
The writing group gratefully acknowledges the leadership and contributions of the late Professor Ian Jacobs, PhD, as both ILCOR Co-Chair and inaugural Chair of the ILCOR Methods Group. Ian is greatly missed by the international resuscitation community.
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Cited by (36)
Trends in neonatal resuscitation patterns in Queensland, Australia — A 10-year retrospective cohort study
2020, ResuscitationCitation Excerpt :The first Australian-specific neonatal resuscitation guidelines were published by the Australian Resuscitation Council (ARC) in 2007 and were based on the 2005 ILCOR CoSTR statement.6–8 These guidelines were updated in 2010 (by the Australian and New Zealand Committee on Resuscitation (ANZCOR); a collaboration of the ARC with the New Zealand Resuscitation Council) in 2010 and 2016 to reflect the 2010 and 2015 ILCOR CoSTRs.5,9,10 Key changes in ARC/ANZCOR neonatal resuscitation guidelines relevant to this study are shown in Supplement Table 1.
Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
2020, ResuscitationCitation Excerpt :It was a very detailed process in which 250 evidence reviewers from 39 countries completed 165 systematic reviews (SysRevs) on resuscitation-related questions. These reviews were completed according to a detailed process, including the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).5,6 These reviews were published in summary format as the 2015 CoSTR.3,4
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The European Resuscitation Council requests that this document be cited as follows: Peter T. Morley, Eddy Lang, Richard Aickin, John E. Billi, Brian Eigel, Jose Maria E. Ferrer, Judith C. Finn, Lana M. Gent, Russell E. Griffin, Mary Fran Hazinski, Ian K. Maconochie, William H. Montgomery, Laurie J. Morrison, Vinay M. Nadkarni, Nikolaos I. Nikolaou, Jerry P. Nolan, Gavin D. Perkins, Michael R. Sayre, Andrew H. Travers, Jonathan Wyllie, David A. Zideman. Part 2: Evidence evaluation and management of conflicts of interest. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015;95:e33–e41.
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This article has been copublished in “Circulation”.