Skip to main content

Introduction

The 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care provides a comprehensive review of evidence-based recommendations for resuscitation and emergency cardiovascular care. The initial guidelines for CPR were published in 1966 by an ad hoc CPR Committee of the Division of Medical Sciences, National Academy of Sciences—National Research Council.1 This occurred in response to requests from several organizations and agencies about the need for standards and guidelines regarding training and response.
Since then, CPR guidelines have been reviewed, updated, and published periodically by the AHA.2–9 In 2015, the process of 5-year updates was transitioned to an online format that uses a continuous evidence evaluation process rather than periodic reviews. This allowed for significant changes in science to be reviewed in an expedited manner and then incorporated directly into the guidelines if deemed appropriate. The intent was that this would increase the potential for more immediate transitions from guidelines to bedside. The approach for this 2020 guidelines document reflects alignment with the International Liaison Committee on Resuscitation (ILCOR) and associated member councils and includes varying levels of evidence reviews specific to the scientific questions considered of greatest clinical significance and new evidence.
Over a half-century after the initial guidelines were published, cardiac arrest remains a leading cause of mortality and morbidity in the United States and other countries worldwide. As reported in the AHA “Heart Disease and Stroke Statistics—2020 Update,” emergency medical services respond to more than 347 000 adults and more than 7000 children (less than 18 years of age) with out-of-hospital cardiac arrest (OHCA) each year in the United States.10 In-hospital cardiac arrest (IHCA) is estimated to occur in 9.7 per 1000 adult cardiac arrests (approximately 292 000 events annually) and 2.7 pediatric events per 1000 hospitalizations.11 In addition, approximately 1% of newly born infants in the United States need intensive resuscitative measures to restore cardiorespiratory function.12,13
Overall, although both adult and pediatric IHCA outcomes have improved steadily since 2004, similar gains are not being seen in OHCA.10 The proportion of adult patients with return of spontaneous circulation (ROSC) following OHCA that is attended by emergency medical services has remained essentially unchanged since 2012.10
Much of the variation in survival rates is thought to be due to the strength of the Chain of Survival (Figure 1), the critical actions that must occur in rapid succession to maximize the chance of survival from cardiac arrest.14 A sixth link, recovery, has been added to each Chain with this version of the guidelines to emphasize the importance of recovery and survivorship for resuscitation outcomes. Analogous Chains of Survival have also been developed for pediatric OHCA and for both adult and pediatric IHCA. Similarly, successful neonatal resuscitation depends on a continuum of integrated lifesaving steps that begins with careful assessment and preparation in advance of birth as well as resuscitation and stabilization at the time of birth and through the first 28 days after birth.15
Figure 1. The American Heart Association Chains of Survival. CPR indicates cardiopulmonary resuscitation.
This executive summary provides an overview of and orientation to the 2020 AHA Guidelines, which are organized around the Utstein Formula for Survival (Figure 2).16
Figure 2. The Utstein Formula for Survival, emphasizing the 3 components essential to improving survival. 16
Each section in this summary describes the scope of each guideline Part, along with a list of the most significant and impactful new or updated recommendations for that Part. Each section also includes a list of critical knowledge gaps that highlights important research questions and significant opportunities for enhancing the Chain of Survival. This executive summary does not contain extensive external reference citations; the reader is referred to Parts 2 through 7 for more detailed reviews of the scientific evidence and corresponding recommendations.15,17–21

Coronavirus Disease 2019 (COVID-19) Guidance

Together with other professional societies, the AHA has provided interim guidance for basic life support (BLS) and advanced life support (ALS) in adults, children, and neonates with suspected or confirmed COVID-19 infection. Because the evidence and guidance are evolving with the COVID-19 situation, that information is maintained separately from the ECC guidelines. Readers are directed to the AHA website22 for the most recent guidance.

Evidence Evaluation and Guidelines Development19

The 2020 Guidelines are based on the extensive evidence evaluation performed in conjunction with ILCOR and the affiliated ILCOR member councils. Three different types of evidence reviews (systematic reviews, scoping reviews, and evidence updates) were used in the 2020 process. Each of these resulted in a description of the literature that facilitated guideline development.23–28 The ILCOR evidence reviews used Grading of Recommendations Assessment, Development, and Evaluation methodology and terminology.29 These AHA treatment recommendations followed standard AHA processes and nomenclature, which are described fully in “Part 2: Evidence Evaluation and Guidelines Development.”19
Each AHA writing group reviewed all relevant and current AHA guidelines for CPR and emergency cardiovascular care,30–41 pertinent 2020 International Consensus on CPR and Emergency Cardiovascular Care Science With Treatment Recommendations evidence evaluations and recommendations,42–48 and all relevant evidence update worksheets to determine whether current guidelines should be reaffirmed, updated, or retired or if new recommendations were needed. The writing groups then drafted, reviewed, and approved recommendations, assigning to each a Class of Recommendation (COR; ie, strength) and Level of Evidence (LOE; ie, quality) (as outlined in Table 3 in Part 2 of this supplement).19
The 2020 Guidelines contain 491 recommendations (Table). Despite recent improvements in support for resuscitation research, 51% of these recommendations are based on limited data and 17% on expert opinion. This highlights the persistent knowledge gaps in resuscitation science that need to be addressed through expanded research initiatives and funding opportunities. With reference to these gaps, we acknowledge the importance of addressing the values and preferences of our key stakeholders: the patients, families, and teams who are involved in the process of resuscitation.
Table. Recommendations in the 2020 Guidelines
ClassificationAdult Basic and Advanced Life SupportPediatric Basic and Advanced Life SupportNeonatal ResuscitationResuscitation Education ScienceSystems of CareTotalPercent
Class (Strength) of Recommendation
 1 (strong)7853165916133%
 2a (moderate)574214131013527%
 2b (weak)89302111615832%
 3: No benefit (moderate)151300194%
 3: Harm (strong)114300184%
Level (Quality) of Evidence
 A2121061%
 B-R3738715511%
 B-NR57198589720%
 C-LD1237024151524851%
 C-EO313715118517%
 Total250130572925491 
EO indicates expert opinion; LD, limited data; NR, nonrandomized; and R, randomized.
The 2020 Guidelines are organized into knowledge chunks, grouped into discrete modules of information on specific topics or management issues.49 Each modular knowledge chunk includes a table of recommendations, a brief introduction or synopsis, recommendation-specific supportive text, hyperlinked references, and, when relevant, figures, flow diagrams of algorithms, and additional tables.

Abbreviations

AbbreviationMeaning/Phrase
ACLSadvanced cardiovascular life support
AEDautomated external defibrillator
AHAAmerican Heart Association
ALSadvanced life support
BLSbasic life support
CORClass of Recommendation
CPRcardiopulmonary resuscitation
IHCAin-hospital cardiac arrest
ILCORInternational Liaison Committee on Resuscitation
LOELevel of Evidence
OHCAout-of-hospital cardiac arrest
PPVpositive-pressure ventilation
ROSCreturn of spontaneous circulation

Adult Basic and Advanced Life Support20

“Part 3: Adult Basic and Advanced Life Support” includes a comprehensive set of recommendations for the care of adult victims of OHCA and IHCA. We reaffirm the critical steps in the Chain of Survival, expand on the postresuscitative care section with the addition of an updated algorithm, and introduce a new link in the Chain of Survival, for recovery and survivorship. The main focus in managing adult cardiac arrest includes rapid recognition, prompt provision of CPR, and defibrillation of ventricular fibrillation and pulseless ventricular tachycardia. Since 2010, the AHA has directed efforts at minimizing the time to provision of chest compressions by focusing the universal sequence of responses on compressions followed by airway and breathing. The 2020 Guidelines continue to highlight the critical importance of chest compressions and leverage current relevant evidence to optimize care and improve survival. Additional recommendations relevant to adult resuscitation appear in “Part 7: Systems of Care.”18

Adult Basic and Advanced Life Support: Significant New, Updated, and Reaffirmed Recommendations

CPR reaffirmed: Provision of CPR has long been the hallmark of cardiac arrest management. Updated evidence from an analysis of over 12 500 patients50 reaffirms the importance of chest compression quality as well as the following:
– During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches, or 5 cm, for an average adult while avoiding excessive chest compression depths (greater than 2.4 inches, or 6 cm)(Class 1, LOE B-NR).51–54
– It is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min (Class 2a, LOE B-NR).50,55
Furthermore, from a new systematic review,44 we recommend that lay rescuers initiate CPR for presumed cardiac arrest because the risk of harm to patients is low if they are not in cardiac arrest (Class 1, LOE C-LD).56–59
Double sequential defibrillation: Along with CPR, early defibrillation is critical to survival when sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia. However, rescuers may encounter victims who are refractory to defibrillation attempts. Double sequential defibrillation—shock delivery by 2 defibrillators nearly simultaneously—has emerged as a new technological approach to manage these patients.60–64 At this time, a systematic review reveals that the usefulness of double sequential defibrillation for refractory shockable rhythm has not been established (Class 2b, LOE C-LD).48
Intravenous (IV) before intraosseous (IO): The peripheral IV route has been the traditional approach for giving emergency pharmacotherapy, although the IO route has grown in popularity and is increasingly implemented as a first-line approach for vascular access. New evidence suggests some uncertainty about the efficacy of the IO route compared with the IV route.65–69 Therefore, it is reasonable for providers to first attempt establishing IV access for drug administration in cardiac arrest (Class 2a, LOE B-NR). IO access may be considered if attempts at IV access are unsuccessful or not feasible (Class 2b, LOE B-NR).
Early epinephrine administration reaffirmed: In 2 randomized clinical trials,70,71 administration of epinephrine increased ROSC and survival, leading to a recommendation that epinephrine be administered for patients in cardiac arrest (Class 1, LOE B-R).40,72 Uncertainty about the effect of epinephrine on neurological outcome, in addition to the variation in outcomes based on timing and initial rhythm, supported the following new concepts:
– With respect to timing, for cardiac arrest with a nonshockable rhythm, it is reasonable to administer epinephrine as soon as feasible (Class 2a, C-LD).
– With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed (Class 2b, C-LD).
The Adult Cardiac Arrest Algorithm has been updated to emphasize the early administration of epinephrine for patients with nonshockable rhythms.
Individualized management of resuscitation: Not all cardiac arrest events are identical, and specialized management may be critical for optimal patient outcome, such as when the primary etiology of arrest is respiratory, a gravid uterus impedes venous return, or resuscitation involves a viable fetus. In the Special Circumstances of Resuscitation section, we highlight 2 such areas (opioid overdose and cardiac arrest in pregnancy):
Opioid overdose: The opioid epidemic has resulted in an increase in respiratory and cardiac arrests due to opioid overdose.73 To address this public health crisis, we present 2 new algorithms for the management of opioid-associated emergencies, highlighting that lay rescuers and trained responders should not delay activating emergency response systems while awaiting the patient’s response to naloxone or other interventions (Class 1, LOE E-O). Additionally, for patients known or suspected to be in cardiac arrest, in the absence of a proven benefit from the use of naloxone, standard resuscitative measures should take priority over naloxone administration, with a focus on high-quality CPR (compressions plus ventilation) (Class 1, LOE E-O).73
Cardiac arrest in pregnancy: We present updated recommendations and a new algorithm highlighting the concept that the best outcomes for both mother and fetus are through successful maternal resuscitation.74 Team planning for cardiac arrest in pregnancy should be done in collaboration with the obstetric, neonatal, emergency, anesthesiology, intensive care, and cardiac arrest services (Class 1, LOE C-LD). Priorities for treating the pregnant woman in cardiac arrest should include provision of high-quality CPR and relief of aortocaval compression through left lateral uterine displacement (Class 1, LOE C-LD). If the pregnant woman with a fundus height at or above the umbilicus has not obtained ROSC with usual resuscitation measures plus manual left lateral uterine displacement, it is advisable to prepare to evacuate the uterus while resuscitation continues (Class 1, LOE C-LD).75–79 To accomplish delivery early, ideally within 5 minutes after the time of arrest, it is reasonable to immediately prepare for perimortem cesarean delivery while initial BLS and advanced cardiovascular life support (ACLS) interventions are being performed (Class 2a, LOE C-EO), although provider skill set and available personnel and resources may also logically influence this timing.74
Point-of-care ultrasound for prognostication: Many have attempted to leverage the use of new technologies like portable ultrasound machines to provide guidance in making decisions on futility and termination of resuscitation. However, on the basis of a synthesis of the evidence,48 we suggest against the use of point-of-care ultrasound for prognostication during CPR (Class 3: No benefit, LOE C-LD). This recommendation does not preclude the use of ultrasound to identify potentially reversible causes of cardiac arrest or detect ROSC.
Postresuscitative care: Post–cardiac arrest care, a critical component of the Chain of Survival, demands a comprehensive, structured, multidisciplinary system of care that should be implemented in a consistent manner for the treatment of post–cardiac arrest patients (Class 1, LOE B-NR).40,80 We present a new algorithm that describes the initial stabilization phase and additional emergency activities after ROSC. Key considerations include blood pressure management, monitoring for and treatment of seizures, and targeted temperature management.
Improving neuroprognostication: Accurate neurological prognostication in cardiac arrest survivors who do not regain consciousness with ROSC is critically important to ensure that patients with significant potential for recovery are not destined for certain poor outcomes due to care withdrawal.81 With updated systematic reviews on multiple aspects of neuroprognostication,48 in patients who remain comatose after cardiac arrest, we recommend that neuroprognostication involve a multimodal approach and not be based on any single finding (Class 1, LOE B-NR).48,81 To assist in this process, we have developed evidence-based guidance to facilitate multimodal prognostication. This includes the following:
– In patients who remain comatose after cardiac arrest, we recommend that neuroprognostication be delayed until adequate time has passed to ensure avoidance of confounding by medication effect or a transiently poor examination in the early postinjury period (Class 1, LOE B-NR).82
– In patients who remain comatose after cardiac arrest, it is reasonable to perform multimodal neuroprognostication at a minimum of 72 hours after the return to normothermia, though individual prognostic tests may be obtained earlier than this (Class 2a, LOE B-NR).48
Further, we provide specific guidance on the use of clinical examination, serum biomarkers, electrophysiological tests, and neuroimaging for neuroprognostication.
Recovery and survivorship: Finally, we have added an additional link in the Chain of Survival: recovery from cardiac arrest. Recovery expectations and survivorship plans that address treatment, surveillance, and rehabilitation need to be provided to cardiac arrest survivors and their caregivers at hospital discharge to address the sequelae of cardiac arrest and optimize transitions of care to independent physical, social, emotional, and role function.83 Recommendations that are critically important to this concept include the following:
– We recommend structured assessment for anxiety, depression, posttraumatic stress, and fatigue for cardiac arrest survivors and their caregivers (Class 1, LOE B-NR)83–87
– We recommend that cardiac arrest survivors have multimodal rehabilitation assessment and treatment for physical, neurological, cardiopulmonary, and cognitive impairments before discharge from the hospital (Class 1, LOE C-LD).83,88–90
– We recommend that cardiac arrest survivors and their caregivers receive comprehensive, multidisciplinary discharge planning, to include medical and rehabilitative treatment recommendations and return to activity/work expectations (Class 1, LOE C-LD).83

Knowledge Gaps

Some of the most pertinent gaps in adult resuscitation research include the following:
What are optimal strategies to enhance lay rescuer performance of CPR?
For patients with an arterial line in place, does targeting CPR to a particular blood pressure improve outcomes?
Can artifact-filtering algorithms for analysis of ECG rhythms during CPR in a real-time clinical setting decrease pauses in chest compressions and improve outcomes?
Does preshock waveform analysis lead to improved outcome?
Does double sequential defibrillation and/or alternative defibrillator pad positioning affect outcome in cardiac arrest with shockable rhythm?
Is the IO route of drug administration safe and efficacious in cardiac arrest, and does efficacy vary by IO site?
Does epinephrine, when administered early after cardiac arrest, improve survival with favorable neurological outcome?
Does the use of point-of-care cardiac ultrasound during cardiac arrest improve outcomes?
Is targeting a specific partial pressure of end-tidal carbon dioxide (ETCO2) value during CPR beneficial, and what degree of rise in ETCO2 indicates ROSC?
Which populations are most likely to benefit from extracorporeal CPR?
Does the treatment of nonconvulsive seizures, which are common in postarrest patients, improve patient outcomes?
Do neuroprotective agents improve favorable neurological outcome after cardiac arrest?
What is the most efficacious management approach for postarrest cardiogenic shock, including pharmacological, catheter intervention, or implantable device?
Does targeted temperature management, compared with strict normothermia, improve outcomes?
What is the optimal duration for targeted temperature management before rewarming?
What is the best approach to rewarming postarrest patients after treatment with targeted temperature management?
Are glial fibrillary acidic protein, serum tau protein, and neurofilament light chain measurements valuable for neuroprognostication?
Do more uniform definitions for status epilepticus, malignant electroencephalogram patterns, and other electroencephalogram patterns enable better comparisons of their prognostic values across studies?
Is there a consistent threshold value for prognostication for gray-white ratio or apparent diffusion coefficient?
What do survivor-derived outcome measures of the impact of cardiac arrest survival look like, and how do they differ from current generic or clinician-derived measures?
Does hospital-based protocolized discharge planning for cardiac arrest survivors improve access to/referral to rehabilitation services or patient outcomes?
Is there benefit to naloxone administration in patients with opioid-associated cardiac arrest who are receiving CPR with ventilation?
What is the ideal initial dose of naloxone in a setting where fentanyl and fentanyl analogues are responsible for a large proportion of opioid overdose?
In cases of suspected opioid overdose managed by a non–healthcare provider who is not capable of reliably checking a pulse, is initiation of CPR beneficial?
What is the ideal timing of perimortem cesarean delivery for a pregnant woman in cardiac arrest?
Which patients with cardiac arrest due to “suspected” pulmonary embolism benefit from emergency thrombolysis during resuscitation?

Pediatric Basic and Advanced Life Support21

Part 4 of the 2020 Guidelines, “Pediatric Basic and Advanced Life Support,” includes recommendations for the treatment of pediatric OHCA and IHCA, including postresuscitation care and survivorship. The causes, treatment, and outcomes of cardiac arrest in children differ from cardiac arrest in adults. For example, pediatric cardiac arrests are more often due to respiratory causes. These guidelines contain recommendations for pediatric BLS and ALS, excluding the newborn period, and are based on the best available resuscitation science. Expansions to pediatric ALS recommendations include care of the child with pulmonary hypertension, congenital heart disease, and post–cardiac arrest recovery. This summary highlights the new and updated recommendations in pediatric BLS and ALS since 2015 that we believe will have a significant impact on process and on patient-related outcomes from cardiac arrest. Additional recommendations related to pediatric resuscitation can be found in “Part 7: Systems of Care.”

Significant New and Updated Recommendations

Respiratory rate: Respiratory rates during pediatric CPR have previously been extrapolated from adult data, because of lack of pediatric studies. New data about respiratory rates during CPR in children are now available. Although limited, these data support a higher respiratory rate for children with an advanced airway than was previously recommended.91 When performing CPR in infants and children with an advanced airway, it may be reasonable to target a respiratory rate range of 1 breath every 2 to 3 seconds (20–30 breaths/min), accounting for age and clinical condition. Rates exceeding these recommendations may compromise hemodynamics (Class 2b, LOE C-LD).91 For infants and children with a pulse but absent or inadequate respiratory effort, it is reasonable to give 1 breath every 2 to 3 seconds (20–30 breaths/min) (Class 2a, LOE C-EO).91
Cuffed endotracheal tubes: Intubation with a cuffed endotracheal tube can improve capnography and ventilation in patients with poor pulmonary compliance and decrease the need for endotracheal tube changes. It is reasonable to choose cuffed endotracheal tubes over uncuffed endotracheal tubes for intubating infants and children (Class 2a, LOE C-LD).92–98
Cricoid pressure: Although cricoid pressure may be useful in certain circumstances, routine use can impede visualization during laryngoscopy and chest rise with bag-mask ventilation. Clinical studies show that routine use of cricoid pressure reduces the rate of first-attempt intubation success. Routine use of cricoid pressure is not recommended during endotracheal intubation of pediatric patients (Class 3: No benefit, LOE C-LD),99,100 and if cricoid pressure is used, discontinue if it interferes with ventilation or the speed or ease of intubation (Class 3: Harm, LOE C-LD).99,100
Early epinephrine: The goal of epinephrine administration during CPR is to optimize coronary perfusion pressure and maintain cerebral perfusion pressure. Earlier administration of epinephrine during CPR may increase survival-to-discharge rates. For pediatric patients in any setting, it is reasonable to administer the initial dose of epinephrine within 5 minutes from the start of chest compressions (Class 2a, LOE C-LD).101–104
Diastolic blood pressure to guide CPR: For patients with continuous invasive arterial blood pressure monitoring in place at the time of cardiac arrest, it is reasonable for providers to use diastolic blood pressure to assess CPR quality (Class 2a, LOE C-LD).105 Although ideal blood pressure targets during CPR are not known, diastolic blood pressure is the main driver of coronary blood flow and may be used to guide interventions if an arterial line is in place.
Seizures after cardiac arrest: Post–cardiac arrest seizures are common. Many are nonconvulsive, which can be detected only with electroencephalography monitoring. When resources are available, continuous electroencephalography monitoring is recommended for the detection of seizures after cardiac arrest in patients with persistent encephalopathy (Class 1, LOE C-LD).106–109 It is recommended to treat clinical seizures that follow cardiac arrest (Class 1, LOE C-LD).110,111 It is reasonable to treat nonconvulsive status epilepticus that follows cardiac arrest, in consultation with experts (Class 2a, LOE C-EO).110,111
Recovery and survivorship: New neurological morbidity after cardiac arrest is common and should be addressed with ongoing assessment and intervention to support patients after hospital discharge. It is recommended that pediatric cardiac arrest survivors be evaluated for rehabilitation services (Class 1, LOE C-LD).112–117 It is reasonable to refer pediatric cardiac arrest survivors for ongoing neurological evaluation for at least the first year after cardiac arrest (Class 2a, LOE C-LD).81,83,115,117–122
Septic shock: Previous AHA guidelines for the management of septic shock included aggressive (20 mL/kg) fluid boluses and lacked additional guidance. In these 2020 Guidelines, a more tailored approach to fluid administration is suggested, and vasopressor recommendations are provided.
– In patients with septic shock, it is reasonable to administer fluid in 10-mL/kg or 20-mL/kg aliquots with frequent reassessment (Class 2a, LOE C-LD).123 Providers should reassess the patient after every fluid bolus to assess for fluid responsiveness and for signs of volume overload (Class 1, LOE C-LD).123–125
– Either isotonic crystalloids or colloids can be effective as the initial fluid choice for resuscitation (Class 2a, LOE B-R).126 Either balanced or unbalanced solutions can be effective as the fluid choice for resuscitation (Class 2a, LOE B-NR).127–129
– In infants and children with fluid-refractory septic shock, it is reasonable to use either epinephrine or norepinephrine as an initial vasoactive infusion (Class 2a, LOE C-LD).130–135
Opioid overdose: Although most victims of opioid overdose are adults, young children suffer opioid overdose from exploratory behavior, and adolescents through opioid abuse or self-harm exposure. Opioid overdose causes respiratory depression, which can progress to respiratory arrest and then cardiac arrest. Pediatric opioid overdose management is the same as for adults. For a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (ie, a respiratory arrest), in addition to providing standard pediatric BLS or ALS care, it is reasonable for responders to administer intramuscular or intranasal naloxone (Class 2a, LOE B-NR).136–149 Empirical administration of intramuscular or intranasal naloxone to all unresponsive opioid-associated life-threatening emergency patients may be reasonable as an adjunct to standard first aid and non–healthcare provider BLS protocols (Class 2b, LOE C-EO).137–145,147–150 New opioid-associated emergency algorithms for lay rescuers and healthcare professionals are provided.

Knowledge Gaps

Some of the most pertinent gaps in pediatric resuscitation research include the following:
What is the optimal route of medication delivery during CPR: IV or IO?
In what time frame should the first dose of epinephrine be administered during pulseless cardiac arrest?
With what frequency should subsequent doses of epinephrine be administered?
With what frequency should the rhythm be checked during CPR?
What are the optimal chest compression rate and ventilation rate during CPR? Are they age dependent? Do they differ when an advanced airway is in place?
Are there specific situations in which advanced airway placement is either beneficial or harmful in OHCA or IHCA? Do they differ based on the etiology of cardiac arrest?
Can echocardiography improve CPR quality or outcomes from cardiac arrest?
What is the role of extracorporeal CPR for infants and children with OHCA and IHCA due to noncardiac causes?
What is the optimal timing and dosing of defibrillation for ventricular fibrillation and pulseless ventricular tachycardia?
What clinical tools can be used to help in the decision to terminate pediatric IHCA and OHCA resuscitation?
What is the optimal blood pressure target during the post–cardiac arrest period?
What are the reliable methods for postarrest prognostication?
What rehabilitation therapies and follow-up should be provided to improve outcomes after cardiac arrest?
What are the most effective and safe medications for adenosine-refractory supraventricular tachycardia?

Neonatal Life Support15

Part 5 of the AHA 2020 Guidelines, “Neonatal Life Support,”15 includes recommendations on how to follow the algorithm that include anticipation and preparation, umbilical cord management at delivery, initial actions, heart rate monitoring, respiratory support, chest compressions, intravascular access and therapies, withholding and discontinuation of resuscitation, postresuscitation care, and human factors and performance. Consistent with the Utstein Formula for Survival, the 2020 Guidelines provide a comprehensive review of recommendations for neonatal resuscitation, including new and updated recommendations that are based on the latest evidence from studies published in the medical literature and reviews completed by ILCOR.

Significant New and Updated Recommendations

Skin-to-skin contact: Placing healthy newborn infants who do not require resuscitation skin-to-skin after birth can be effective in improving breastfeeding, temperature control, and blood glucose stability (Class 2a, LOE B-R). A Cochrane systematic review found that healthy infants receiving skin-to-skin contact were more likely to be breastfed at 1 to 4 months of age. In addition, blood glucose after birth was meaningfully higher and cardiorespiratory stability was also improved with skin-to-skin contact.151
Intubation for meconium: For nonvigorous newborns (presenting with apnea or ineffective breathing effort) delivered through meconium-stained amniotic fluid, routine laryngoscopy, with or without tracheal suctioning, is not recommended (Class 3: No benefit, LOE C-LD). For nonvigorous newborns delivered through meconium-stained amniotic fluid who have evidence of airway obstruction during positive-pressure ventilation (PPV), intubation and tracheal suction can be beneficial (Class 2a, LOE C-EO). Endotracheal suctioning is indicated only if airway obstruction is suspected after providing PPV.46
Vascular access: For babies requiring vascular access at the time of delivery, the umbilical vein is the recommended route (Class 1, LOE C-EO). If IV access is not feasible, it may be reasonable to use the IO route (Class 2b, LOE C-EO). Babies who have failed to respond to PPV and chest compressions require vascular access to infuse epinephrine and/or volume expanders. Umbilical venous catheterization is the preferred technique in the delivery room.46,152 IO access is an alternative if umbilical venous access is not feasible or care is being provided outside of the delivery room.46
Termination of resuscitation: In newly born babies receiving resuscitation, if there is no heart rate and all the steps of resuscitation have been performed, cessation of resuscitation efforts should be discussed with the healthcare team and the family. A reasonable time frame for this change in goals of care is around 20 minutes after birth (Class 1, LOE C-LD). Newly born babies who have failed to respond to resuscitative efforts by approximately 20 minutes of age have a low likelihood of survival. For this reason, a time frame for decisions relating to discontinuation of resuscitation efforts is suggested, emphasizing engagement of parents and the resuscitation team before redirecting care.46,153

Knowledge Gaps

Some of the most pertinent gaps in neonatal resuscitation research include the following:
What is the optimal management of the umbilical cord at delivery, especially in the baby who appears to need respiratory support?
What is the optimal oxygen management at all stages of resuscitation, including when initiating PPV, when providing chest compressions, and after resuscitation?
What are the optimal dosing, timing, and route of administration for epinephrine?
What is the optimal management for the detection and treatment of hypovolemia?
How should neonatal resuscitation be modified in non–delivery room settings?
What strategies are most effective for optimizing provider and team performance, including training methods, the frequency of retraining intervals, and the approach to briefing, debriefing, and feedback?

Resuscitation Education Science17

Part 6 of the 2020 Guidelines, “Resuscitation Education Science,” includes recommendations about various instructional design features in resuscitation training, including deliberate practice, spaced learning, booster training, teamwork and leadership training, in situ education, manikin fidelity, CPR feedback devices, virtual reality and gamified learning, and precourse preparation.17 We also discuss educational strategies to support lay rescuer training and efforts to address the opioid epidemic. The second section of Part 6 describes how specific provider considerations may influence the impact of educational interventions. We offer recommendations to address disparities in education and in willingness to provide CPR, and we outline how practitioner experience and participation in ACLS courses influence patient outcomes from cardiac arrest. Additional recommendations related to resuscitation education science can be found in “Part 7: Systems of Care.”18

Significant New and Updated Recommendations

Booster training: It is recommended to implement booster sessions when using a massed learning approach for resuscitation training (Class 1, LOE B-R). Most current resuscitation courses use a massed learning approach: a single training event lasting hours or days coupled with retraining every 1 to 2 years.154 The addition of booster training sessions (ie, brief, frequent sessions focused on repetition of prior content) to resuscitation courses is associated with improved CPR skill retention over 12 months.155–161 The frequency of booster sessions should be balanced against learner attrition (ie, higher attrition rates with more frequent sessions155) and the availability of resources to support implementation of booster training.
Spaced learning: It is reasonable to use a spaced learning approach in place of a massed learning approach for resuscitation training (Class 2a, LOE B-R).162–164 In contrast to the traditional or massed learning approach involving a 1- or 2-day course, a spaced learning approach separates training into multiple sessions over time, with intervals of weeks to months between sessions. Each spaced session involves the presentation of new content and may include repetition of content from prior sessions.162–164 Two randomized clinical trials in pediatric resuscitation training report that a spaced learning approach results in improved clinical performance and technical skills (IO insertion, bag-mask ventilation) in comparison to a traditional 1- or 2-day course.162,164 Because new content and/or skills are presented at each session, learner attendance across all sessions is required to ensure course completion.
Deliberate practice and mastery learning: Incorporating a deliberate practice and mastery learning model into BLS or ALS courses may be considered for improving skill acquisition and performance (Class 2b, LOE B-NR). Deliberate practice is a training approach where learners are given (1) a discrete goal to achieve, (2) immediate feedback on their performance, and (3) ample time for repetition to improve performance.165 Mastery learning is the use of deliberate-practice training along with testing that uses a set of criteria to define a minimum passing standard that implies mastery of the tasks being learned.166 Studies incorporating a deliberate-practice and mastery-learning model into training demonstrated improved learner performance in resuscitation skills.167–174 Coupling repetition with feedback and allowing sufficient time to achieve competency are key elements associated with improved outcomes.
In situ simulation training: It is reasonable to conduct in situ simulation-based resuscitation training in addition to traditional training (Class 2a, LOE C-LD). In situ simulation is a form of simulation training activities that occurs in actual patient-care areas.175 One advantage of in situ training is that it provides learners with a more realistic training environment. In situ training can be focused on the development of individual provider technical skills or team-based skills, including communication, leadership, role allocation, and situational awareness.176,177 When added to other educational strategies, in situ training has a positive impact on learning and on performance outcomes.161,164,178–182 The advantages of in situ training should be weighed against the risks of training in clinical spaces.
Lay rescuer training: A combination of self-instruction and instructor-led teaching with hands-on training is recommended as an alternative to instructor-led courses for lay rescuers. If instructor-led training is not available, self-directed training is recommended for lay rescuers (Class 1, LOE C-LD).183–186 The primary goal of resuscitation training for lay rescuers (ie, non–healthcare professionals) is to increase immediate bystander CPR rates, automated external defibrillator (AED) use, and timely emergency response system activation during an OHCA. Studies comparing self-instruction or video-based instruction with instructor-led training demonstrate no significant differences in performance outcomes.183–186 A shift to more self-directed training may lead to a higher proportion of trained lay rescuers, thus increasing the chances that a trained lay rescuer will be available during OHCA.
Training school-age children: It is recommended to train middle school– and high school–age children in how to perform high-quality CPR (Class 1, LOE C-LD).187–195 Training school-age children to perform CPR instills confidence and a positive attitude toward responding to an OHCA event.187–195 Targeting this population with CPR training helps to build the future cadre of community-based, trained lay rescuers.
Disparities in CPR training: Eliminating disparities in CPR training could improve bystander CPR rates and outcomes from cardiac arrest in populations with historically low rates of bystander CPR. Communities with predominantly black and Hispanic populations and those with lower socioeconomic status have lower rates of bystander CPR and CPR training.196–206 It is recommended to target and tailor lay rescuer CPR training to specific racial and ethnic populations and neighborhoods in the United States (Class 1, LOE B-NR).196–200,207–211 It is recommended to target low–socioeconomic status populations and neighborhoods for layperson CPR training and awareness efforts (Class 1, LOE B-NR).201–206,212–215 Targeting training efforts should consider barriers such as language, financial considerations, and poor access to information.
Barriers to bystander CPR for women: Women are often less likely to receive bystander CPR because rescuers often fear accusations of inappropriate touching, sexual assault, or injuring the victim.216,217 It is reasonable to address barriers to bystander CPR for female victims through educational training and public awareness efforts (Class 2a, LOE C-LD).216–219 Targeted training may help to overcome these barriers and improve bystander CPR rates for female victims.
Advanced Cardiovascular Life Support course participation: It is reasonable for healthcare professionals to take an adult ACLS course or equivalent training (Class 2a, LOE C-LD).220–228 For more than 3 decades, the ACLS course has been recognized as an essential component of resuscitation training for frontline, acute-care providers. A recent systematic review found that having resuscitation teams with 1 or more team members trained in ACLS results in improved patient outcomes.228 This recommendation supports the use of the ACLS course as foundational training for acute-care providers.

Knowledge Gaps

Some of the most pertinent gaps in resuscitation education research include the following:
Which educational interventions most impact real-world performance and clinical outcomes, as opposed to educational outcomes or performance in training?
How can instructional design features be combined or blended to optimize outcomes? Future studies should evaluate the synergistic effects of instructional design features when used in a blended manner (eg, in situ simulation training delivered as booster sessions).
What are the most effective ways to train and develop resuscitation instructors? Future research should evaluate the impact of various faculty-development strategies on instructor skills and learner outcomes.

Systems of Care18

Part 7 of the 2020 Guidelines focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations and to persons of all ages. The systems of care guidelines are organized around the Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post–cardiac arrest care and survivorship. Recommendations focused on OHCA include community initiatives to promote cardiac arrest recognition, CPR, public access defibrillation, the use of mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Relevant to IHCA are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. Additional recommendations address clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement.

Significant New and Updated Recommendations

Summoning willing bystanders: Emergency dispatch systems should alert willing bystanders to nearby events that may require CPR or AED use through mobile phone technology (Class 1, LOE B-NR). Despite the recognized role of lay rescuers in improving OHCA outcomes, most communities experience low rates of bystander CPR and AED use.229,230 Mobile phone technology, such as text messages and mobile phone apps, is available to summon trained members of the general public to nearby events to assist in CPR and to direct those responders to the nearest AED.231 Notification of lay rescuers via a mobile phone app results in improved bystander response times, higher bystander CPR rates, shorter time to defibrillation, and higher rates of survival to hospital discharge.47 As this technology becomes more ubiquitous, studies exploring the impact of these alerts on cardiac arrest outcomes for diverse patient, community, and geographic contexts are needed.
Cognitive aids and checklists: It may be reasonable to use cognitive aids to improve team performance of healthcare providers during CPR (Class 2b, LOE C-LD). Cognitive aids are prompts designed to help individuals and teams to recall information, complete tasks, and adhere to guideline recommendations.232 Examples include pocket cards, posters, checklists, mobile apps, and mnemonics. Although the use of cognitive aids in trauma resuscitation improves adherence to resuscitation guidelines, reduces errors, and improves survival,233–236 there are no studies evaluating their use by healthcare teams in cardiac arrest.47
Data for continuous improvement: Continuous improvement starts with disciplined collection and evaluation of data on resuscitation performance and outcomes. It is reasonable for organizations that treat cardiac arrest patients to collect processes-of-care data and outcomes (Class 2a, LOE C-LD). Clinical registries collect information on the processes of care (CPR performance, defibrillation times) and outcomes of care (ROSC, survival) associated with real-world management of cardiac arrest. Registries provide information that can be used to identify opportunities to improve the quality of care. A recent systematic review found improvement in cardiac arrest survival in organizations and communities that implemented cardiac arrest registries.47

Knowledge Gaps

Some of the most pertinent gaps in systems of care research include the following:
Which interventions improve the willingness of the general public to perform CPR and use AEDs, especially for populations and communities with low bystander response rates?
Does just-in-time AED delivery, including drone delivery of AEDs, increase the number of patients receiving timely defibrillation and improve resuscitation outcomes?
Which clinical criteria accurately identify patients at increased risk for IHCA?
What are the ideal components of a hospital rapid response system and rapid response team? How can these factors be integrated into a realistic and effective response model for the prevention of IHCA?
What is the best structure for individual, team, and system feedback to achieve performance improvement?
In what settings are community CPR and AED programs cost-effective?

Implementing the Guidelines

In this executive summary, we presented an overview of the guidelines process, recommendations, and knowledge gaps that can be translated into practice. Future efforts can focus on evaluating the feasibility and acceptability of recommendations, their cost-effectiveness, and their impact on equity, although such evaluations are outside the scope of this document.

Summary

Cardiac arrest remains a condition with considerable morbidity and mortality that broadly affects individuals across age, gender, race, geography, and socioeconomic status. Although there have been modest improvements in survival, there is still considerable work to be done to address the significant burden of this disease. This executive summary provides an overview of new or updated recommendations that are based on rigorous evidence evaluations and included in the 2020 Guidelines.
To continue to make progress toward addressing this condition over the next decade will require further strengthening the Chain of Survival and enhancing coordinated systems of care. Knowledge gaps identified in the 2020 Guidelines point to critically important research questions that should be addressed and that represent opportunities for funding the future trajectory of resuscitation science. Developing guidelines is an important initial step that can advance efforts that will ultimately result in improved outcomes for patients.

Acknowledgments

The writing group acknowledges the members of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups.

Article Information

The American Heart Association requests that this document be cited as follows: Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ; on behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S337–S357. doi: 10.1161/CIR.0000000000000918

References

1.
National Academy of Sciences. Cardiopulmonary resuscitation. JAMA. 1966;198:372–379.
2.
Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC), 3: advanced life support. JAMA. 1974;227(suppl):852–860.
3.
Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) JAMA. 1980;244:453–509.
4.
Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC): National Academy of Sciences—National Research Council. JAMA. 1986;255:2905–2989.
5.
Guidelines for cardiopulmonary resuscitation and emergency cardiac care: Emergency Cardiac Care Committee and Subcommittees, American Heart Association, Part I: introduction. JAMA. 1992;268:2171–2183.
6.
The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 6: advanced cardiovascular life support: 7D: the tachycardia algorithms. Circulation. 2000;102(suppl):I158–I165.
7.
ECC Committee, Subcommittees, Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112(suppl):IV1–IV203. doi: 10.1161/CIRCULATIONAHA.105.166550.
8.
Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656. doi: 10.1161/CIRCULATIONAHA.110.970889.
9.
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, et al. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S315–S367. doi: 10.1161/CIR.0000000000000252.
10.
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757.
11.
Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, Yankama T, Donnino MW, Andersen LW; American Heart Association’s Get With The Guidelines–Resuscitation Investigators. Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12:e005580. doi: 10.1161/CIRCOUTCOMES.119.005580
12.
Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adolesc Med. 1995;149:20-25. doi: 10.1001/archpedi.1995.02170130022005.
13.
Barber CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics. 2006;118:1028–1034. doi: 10.1542/peds.2006-0416.
14.
Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation. 1991;83:1832–1847. doi: 10.1161/01.cir.83.5.1832.
15.
Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, et al. Part 5: neonatal resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S524–S550. doi: 10.1161/CIR.0000000000000902.
16.
Søreide E, Morrison L, Hillman K, Monsieurs K, Sunde K, Zideman D, Eisenberg M, Sterz F, Nadkarni VM, Soar J, Nolan JP; Utstein Formula for Survival Collaborators. The formula for survival in resuscitation. Resuscitation. 2013;84:1487–1493. doi: 10.1016/j.resuscitation.2013.07.020.
17.
Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, et al. Part 6: resuscitation education science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S551–S579. doi: 10.1161/CIR.0000000000000903.
18.
Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, et al. ; on behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, and Resuscitation Education Science Writing Groups. Part 7: systems of care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S580–S604. doi: 10.1161/CIR.0000000000000899.
19.
Magid DJ, Aziz K, Cheng A, Hazinski MF, Hoover AV, Mahgoub M, Panchal AR, Sasson C, Topjian AA, Rodriguez AJ, et al. Part 2: evidence evaluation and guidelines development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S358–S365. doi: 10.1161/CIR.0000000000000898.
20.
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, et al; on behalf of the Adult Basic and Advanced Life Support Writing Group. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S366–S468. doi: 10.1161/CIR.0000000000000916.
21.
Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, et al; on behalf of the Pediatric Basic and Advanced Life Support Collaborators. Part 4: pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S469–S523. doi: 10.1161/CIR.0000000000000901.
22.
American Heart Association. Coronavirus (COVID-19) resources for CPR training & resuscitation. https://cpr.heart.org/en/resources/coronavirus-covid19-resources-for-cpr-training. Accessed June 24, 2020.
23.
International Liaison Committee on Resuscitation. Continuous evidence evaluation guidance and templates. https://www.ilcor.org/documents/continuous-evidence-evaluation-guidance-and-templates. Accessed December 31, 2019.
24.
Institute of Medicine (US) Committee of Standards for Systematic Reviews of Comparative Effectiveness Research. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press; 2011.
25.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. doi: 10.7326/M18-0850.
26.
PRISMA. PRISMA for scoping reviews. http://www.prisma-statement.org/Extensions/ScopingReviews. Accessed December 31, 2019.
27.
International Liaison Committee on Resuscitation (ILCOR). Continuous evidence evaluation guidance and templates: 2020 evidence update worksheet final. https://www.ilcor.org/documents/continuous-evidence-evaluation-guidance-and-templates#Templates. Accessed December 31, 2019.
28.
International Liaison Committee on Resuscitation (ILCOR). Continuous evidence evaluation guidance and templates: 2020 evidence update process final. https://www.ilcor.org/documents/continuous-evidence-evaluation-guidance-and-templates. Accessed December 31, 2019.
29.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD.
30.
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. 2010;122(suppl 3):S640–S946.
31.
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S315–S589.
32.
Atkins DL, de Caen AR, Berger S, Samson RA, Schexnayder SM, Joyner BL, Bigham BL, Niles DE, Duff JP, Hunt EA, Meaney PA. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;137:e1–e6. doi: 10.1161/CIR.0000000000000540.
33.
Charlton NP, Pellegrino JL, Kule A, Slater TM, Epstein JL, Flores GE, Goolsby CA, Orkin AM, Singletary EM, Swain JM. 2019 American Heart Association and American Red Cross Focused Update for First Aid: Presyncope: An Update to the American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2019;140:e931–e938. doi: 10.1161/CIR.0000000000000730.
34.
Duff JP, Topjian A, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138:e731–e739. doi: 10.1161/CIR.0000000000000612.
35.
Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019;140:e904–e914. doi: 10.1161/CIR.0000000000000731.
36.
Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, et al. 2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2019;140:e915–e921. doi: 10.1161/CIR.0000000000000736.
37.
Escobedo MB, Aziz K, Kapadia VS, Lee HC, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin JG. 2019 American Heart Association Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019;140:e922–e930. doi: 10.1161/CIR.0000000000000729.
38.
Kleinman ME, Goldberger ZD, Rea T, Swor RA, Bobrow BJ, Brennan EE, Terry M, Hemphill R, Gazmuri RJ, Hazinski MF, Travers AH. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;137:e7–e13. doi: 10.1161/CIR.0000000000000539.
39.
Panchal AR, Berg KM, Cabañas JG, Kurz MC, Link MS, Del Rios M, Hirsch KG, Chan PS, Hazinski MF, Morley PT, Donnino MW, Kudenchuk PJ. 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019;140:e895–e903. doi: 10.1161/CIR.0000000000000733.
40.
Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, et al. 2019 American Heart Association focused update on advanced cardiovascular life support: use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2019;140:e881–e894. doi: 10.1161/CIR.0000000000000732.
41.
Panchal AR, Berg KM, Kudenchuk PJ, Del Rios M, Hirsch KG, Link MS, Kurz MC, Chan PS, Cabañas JG, Morley PT, Hazinski MF, Donnino MW. 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138:e740–e749. doi: 10.1161/CIR.0000000000000613.
42.
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, et al. Executive summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S2–S27. doi: 10.1161/CIR.0000000000000890.
43.
Morley PT, Atkins DL, Finn JC, Maconochie I, Nolan JP, Rabi Y, Singletary EM, Wang TL, Welsford M, Olasveengen TM, et al. Evidence evaluation process and management of potential conflicts of interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S28–S40. doi: 10.1161/CIR.0000000000000891.
44.
Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, et al; on behalf of the Adult Basic Life Support Collaborators. Adult basic life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S41–S91. doi: 10.1161/CIR.0000000000000892.
45.
Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian A-M, Nadkarni VM, Ng K-C, Nuthall GA, et al; on behalf of the Pediatric Life Support Collaborators. Pediatric life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S140–S184. doi: 10.1161/CIR.0000000000000894.
46.
Wyckoff MH, Wyllie J, Aziz K, de Almeida MF, Fabres J, Fawke J, Guinsburg R, Hosono S, Isayama T, Kapadia VS, et al; on behalf of the Neonatal Life Support Collaborators. Neonatal life support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S185–S221. doi: 10.1161/CIR.0000000000000895.
47.
Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh M-J, Iwami T, et al; on behalf of the Education, Implementation, and Teams Collaborators. Education, implementation, and teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S222–S283. doi: 10.1161/CIR.0000000000000896.
48.
Berg KM, Soar J, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D’Arrigo S, Deakin CD, et al; on behalf of the Adult Advanced Life Support Collaborators. Adult advanced life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S92–S139. doi: 10.1161/CIR.0000000000000893.
49.
Levine GN, O’Gara PT, Beckman JA, Al-Khatib SM, Birtcher KK, Cigarroa JE, de Las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Hlatky MA, Joglar JA, Piano MR, Wijeysundera DN. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e879–e886. doi: 10.1161/CIR.0000000000000651.
50.
Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, Nishiyama C, Hatanaka T, Mancini ME, Chung SP, Escalante-Kanashiro R, Morley P. Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review. Resuscitation. 2020;146:188–202. doi: 10.1016/j.resuscitation.2019.08.042.
51.
Stiell IG, Brown SP, Nichol G, Cheskes S, Vaillancourt C, Callaway CW, Morrison LJ, Christenson J, Aufderheide TP, Davis DP, Free C, Hostler D, Stouffer JA, Idris AH; Resuscitation Outcomes Consortium Investigators. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation. 2014;130:1962–1970. doi: 10.1161/CIRCULATIONAHA.114.008671.
52.
Stiell IG, Brown SP, Christenson J, Cheskes S, Nichol G, Powell J, Bigham B, Morrison LJ, Larsen J, Hess E, Vaillancourt C, Davis DP, Callaway CW; Resuscitation Outcomes Consortium (ROC) Investigators. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med. 2012;40:1192–1198. doi: 10.1097/CCM.0b013e31823bc8bb.
53.
Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, Merchant RM, Hoek TL, Steen PA, Becker LB. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006;71:137–145. doi: 10.1016/j.resuscitation.2006.04.008.
54.
Babbs CF, Kemeny AE, Quan W, Freeman G. A new paradigm for human resuscitation research using intelligent devices. Resuscitation. 2008;77:306–315. doi: 10.1016/j.resuscitation.2007.12.018.
55.
Hwang SO, Cha KC, Kim K, Jo YH, Chung SP, You JS, Shin J, Lee HJ, Park YS, Kim S, et al. A randomized controlled trial of compression rates during cardiopulmonary resuscitation. J Korean Med Sci. 2016;31:1491–1498. doi: 10.3346/jkms.2016.31.9.1491.
56.
White L, Rogers J, Bloomingdale M, Fahrenbruch C, Culley L, Subido C, Eisenberg M, Rea T. Dispatcher-assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest. Circulation. 2010;121:91–97. doi: 10.1161/CIRCULATIONAHA.109.872366.
57.
Haley KB, Lerner EB, Pirrallo RG, Croft H, Johnson A, Uihlein M. The frequency and consequences of cardiopulmonary resuscitation performed by bystanders on patients who are not in cardiac arrest. Prehosp Emerg Care. 2011;15:282–287. doi: 10.3109/10903127.2010.541981.
58.
Moriwaki Y, Sugiyama M, Tahara Y, Iwashita M, Kosuge T, Harunari N, Arata S, Suzuki N. Complications of bystander cardiopulmonary resuscitation for unconscious patients without cardiopulmonary arrest. J Emerg Trauma Shock. 2012;5:3–6. doi: 10.4103/0974-2700.93094.
59.
Tanaka Y, Nishi T, Takase K, Yoshita Y, Wato Y, Taniguchi J, Hamada Y, Inaba H. Survey of a protocol to increase appropriate implementation of dispatcher-assisted cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Circulation. 2014;129:1751–1760. doi: 10.1161/CIRCULATIONAHA.113.004409.
60.
Beck LR, Ostermayer DG, Ponce JN, Srinivasan S, Wang HE. Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest. Prehosp Emerg Care. 2019;23:597–602. doi: 10.1080/10903127.2019.1584256.
61.
Mapp JG, Hans AJ, Darrington AM, Ross EM, Ho CC, Miramontes DA, Harper SA, Wampler DA; Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group. Prehospital Double Sequential Defibrillation: A Matched Case-Control Study. Acad Emerg Med. 2019;26:994–1001. doi: 10.1111/acem.13672.
62.
Ross EM, Redman TT, Harper SA, Mapp JG, Wampler DA, Miramontes DA. Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis. Resuscitation. 2016;106:14–17. doi: 10.1016/j.resuscitation.2016.06.011.
63.
Emmerson AC, Whitbread M, Fothergill RT. Double sequential defibrillation therapy for out-of-hospital cardiac arrests: The London experience. Resuscitation. 2017;117:97–101. doi: 10.1016/j.resuscitation.2017.06.011.
64.
Cheskes S, Dorian P, Feldman M, McLeod S, Scales DC, Pinto R, Turner L, Morrison LJ, Drennan IR, Verbeek PR. Double sequential external defibrillation for refractory ventricular fibrillation: the DOSE VF pilot randomized controlled trial. Resuscitation. 2020;150:178–184. doi: 10.1016/j.resuscitation.2020.02.010.
65.
Granfeldt A, Avis SR, Lind PC, Holmberg MJ, Kleinman M, Maconochie I, Hsu CH, Fernanda de Almeida M, Wang TL, Neumar RW, Andersen LW. Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review. Resuscitation. 2020;149:150–157. doi: 10.1016/j.resuscitation.2020.02.025.
66.
Feinstein BA, Stubbs BA, Rea T, Kudenchuk PJ. Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2017;117:91–96. doi: 10.1016/j.resuscitation.2017.06.014.
67.
Kawano T, Grunau B, Scheuermeyer FX, Gibo K, Fordyce CB, Lin S, Stenstrom R, Schlamp R, Jenneson S, Christenson J. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2018;71:588–596. doi: 10.1016/j.annemergmed.2017.11.015.
68.
Clemency B, Tanaka K, May P, Innes J, Zagroba S, Blaszak J, Hostler D, Cooney D, McGee K, Lindstrom H. Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest. Am J Emerg Med. 2017;35:222–226. doi: 10.1016/j.ajem.2016.10.052.
69.
Nguyen L, Suarez S, Daniels J, Sanchez C, Landry K, Redfield C. Effect of Intravenous Versus Intraosseous Access in Prehospital Cardiac Arrest. Air Med J. 2019;38:147–149. doi: 10.1016/j.amj.2019.02.005.
70.
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation. 2011;82:1138–1143. doi: 10.1016/j.resuscitation.2011.06.029.
71.
Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, Black JJM, Moore F, Fothergill RT, Rees N, O’Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, Lall R; PARAMEDIC2 Collaborators. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018;379:711–721. doi: 10.1056/NEJMoa1806842.
72.
Holmberg MJ, Issa MS, Moskowitz A, Morley P, Welsford M, Neumar RW, Paiva EF, Coker A, Hansen CK, Andersen LW, Donnino MW, Berg KM; International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators. Vasopressors during adult cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2019;139:106–121. doi: 10.1016/j.resuscitation.2019.04.008.
73.
Dezfulian C, Orkin AM, Maron BA, Elmer J, Girota S, Gladwin MT, Merchant RM, Panchal AR, Perman SM, Starks M, et al; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for healthcare and public responses: a scientific statement from the American Heart Association. Circulation. In press.
74.
Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, Page RL, Griffin RE, Jain A, Dainty KN, Arafeh J, Windrim R, Koren G, Callaway CW; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015;132:1747–1773. doi: 10.1161/CIR.0000000000000300.
75.
Dijkman A, Huisman CM, Smit M, Schutte JM, Zwart JJ, van Roosmalen JJ, Oepkes D. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. 2010;117:282–287. doi: 10.1111/j.1471-0528.2009.02461.x.
76.
Page-Rodriguez A, Gonzalez-Sanchez JA. Perimortem cesarean section of twin pregnancy: case report and review of the literature. Acad Emerg Med. 1999;6:1072–1074. doi: 10.1111/j.1553-2712.1999.tb01199.x.
77.
Cardosi RJ, Porter KB. Cesarean delivery of twins during maternal cardiopulmonary arrest. Obstet Gynecol. 1998;924 Pt 2695–697. doi: 10.1016/s0029-7844(98)00127-6.
78.
Rees SG, Thurlow JA, Gardner IC, Scrutton MJ, Kinsella SM. Maternal cardiovascular consequences of positioning after spinal anaesthesia for Caesarean section: left 15 degree table tilt vs. left lateral. Anaesthesia. 2002;57:15–20. doi: 10.1046/j.1365-2044.2002.02325.x.
79.
Mendonca C, Griffiths J, Ateleanu B, Collis RE. Hypotension following combined spinal-epidural anaesthesia for Caesarean section. Left lateral position vs. tilted supine position. Anaesthesia. 2003;58:428–431. doi: 10.1046/j.1365-2044.2003.03090.x.
80.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, et al. Part 8: post–cardiac arrest care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S465–482. doi: 10.1161/cir.0000000000000262.
81.
Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, Lang E, Licht DJ, Marino BS, McNair ND, Peberdy MA, Perman SM, Sims DB, Soar J, Sandroni C; American Heart Association Emergency Cardiovascular Care Committee. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2019;140:e517–e542. doi: 10.1161/CIR.0000000000000702.
82.
Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocritical care. 2011;15:113–119. doi: 10.1007/s12028-010-9412-8.
83.
Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC; American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; Council on Quality of Care and Outcomes Research; and Stroke Council. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation. 2020;141:e654–e685. doi: 10.1161/CIR.0000000000000747.
84.
Wilder Schaaf KP, Artman LK, Peberdy MA, Walker WC, Ornato JP, Gossip MR, Kreutzer JS; Virginia Commonwealth University ARCTIC Investigators. Anxiety, depression, and PTSD following cardiac arrest: a systematic review of the literature. Resuscitation. 2013;84:873–877. doi: 10.1016/j.resuscitation.2012.11.021.
85.
Presciutti A, Verma J, Pavol M, Anbarasan D, Falo C, Brodie D, Rabbani LE, Roh DJ, Park S, Claassen J, Agarwal S. Posttraumatic stress and depressive symptoms characterize cardiac arrest survivors’ perceived recovery at hospital discharge. Gen Hosp Psychiatry. 2018;53:108–113. doi: 10.1016/j.genhosppsych.2018.02.006.
86.
Presciutti A, Sobczak E, Sumner JA, Roh DJ, Park S, Claassen J, Kronish I, Agarwal S. The impact of psychological distress on long-term recovery perceptions in survivors of cardiac arrest. J Crit Care. 2019;50:227–233. doi: 10.1016/j.jcrc.2018.12.011.
87.
Lilja G, Nilsson G, Nielsen N, Friberg H, Hassager C, Koopmans M, Kuiper M, Martini A, Mellinghoff J, Pelosi P, Wanscher M, Wise MP, Östman I, Cronberg T. Anxiety and depression among out-of-hospital cardiac arrest survivors. Resuscitation. 2015;97:68–75. doi: 10.1016/j.resuscitation.2015.09.389.
88.
Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med. 2015;41:2039–2056. doi: 10.1007/s00134-015-4051-3.
89.
Moulaert VR, Verbunt JA, Bakx WG, Gorgels AP, de Krom MC, Heuts PH, Wade DT, van Heugten CM. ‘Stand still., and move on’, a new early intervention service for cardiac arrest survivors and their caregivers: rationale and description of the intervention. Clin Rehabil. 2011;25:867–879. doi: 10.1177/0269215511399937.
90.
Cowan MJ, Pike KC, Budzynski HK. Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival. Nurs Res. 2001;50:68–76. doi: 10.1097/00006199-200103000-00002.
91.
Sutton RM, Reeder RW, Landis WP, Meert KL, Yates AR, Morgan RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Notterman DA, Holubkov R, Dean JM, Nadkarni VM, Berg RA; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes. Crit Care Med. 2019;47:1627–1636. doi: 10.1097/CCM.0000000000003898.
92.
Chen L, Zhang J, Pan G, Li X, Shi T, He W. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis. Open Med (Wars). 2018;13:366–373. doi: 10.1515/med-2018-0055.
93.
Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 2016;30:3–11. doi: 10.1007/s00540-015-2062-4.
94.
De Orange FA, Andrade RG, Lemos A, Borges PS, Figueiroa JN, Kovatsis PG. Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under. Cochrane Database Syst Rev. 2017;11:CD011954. doi: 10.1002/14651858.CD011954.pub2.
95.
Chambers NA, Ramgolam A, Sommerfield D, Zhang G, Ledowski T, Thurm M, Lethbridge M, Hegarty M, von Ungern-Sternberg BS. Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia. 2018;73:160–168. doi: 10.1111/anae.14113.
96.
de Wit M, Peelen LM, van Wolfswinkel L, de Graaff JC. The incidence of postoperative respiratory complications: A retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0-7 years of age. Paediatr Anaesth. 2018;28:210–217. doi: 10.1111/pan.13340.
97.
Schweiger C, Marostica PJ, Smith MM, Manica D, Carvalho PR, Kuhl G. Incidence of post-intubation subglottic stenosis in children: prospective study. J Laryngol Otol. 2013;127:399–403. doi: 10.1017/S002221511300025X.
98.
Dorsey DP, Bowman SM, Klein MB, Archer D, Sharar SR. Perioperative use of cuffed endotracheal tubes is advantageous in young pediatric burn patients. Burns. 2010;36:856–860. doi: 10.1016/j.burns.2009.11.011.
99.
Kojima T, Laverriere EK, Owen EB, Harwayne-Gidansky I, Shenoi AN, Napolitano N, Rehder KJ, Adu-Darko MA, Nett ST, Spear D, et al; and the National Emergency Airway Registry for Children (NEAR4KIDS) Collaborators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children. Pediatr Crit Care Med. 2018;19:106–114. doi: 10.1097/PCC.0000000000001373.
100.
Kojima T, Harwayne-Gidansky I, Shenoi AN, Owen EB, Napolitano N, Rehder KJ, Adu-Darko MA, Nett ST, Spear D, Meyer K, Giuliano JS, Tarquinio KM, Sanders RC, Lee JH, Simon DW, Vanderford PA, Lee AY, Brown CA, Skippen PW, Breuer RK, Toedt-Pingel I, Parsons SJ, Gradidge EA, Glater LB, Culver K, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med. 2018;19:528–537. doi: 10.1097/PCC.0000000000001531.
101.
Andersen LW, Berg KM, Saindon BZ, Massaro JM, Raymond TT, Berg RA, Nadkarni VM, Donnino MW; American Heart Association Get With the Guidelines–Resuscitation Investigators. Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest. JAMA. 2015;314:802–810. doi: 10.1001/jama.2015.9678.
102.
Lin YR, Wu MH, Chen TY, Syue YJ, Yang MC, Lee TH, Lin CM, Chou CC, Chang CF, Li CJ. Time to epinephrine treatment is associated with the risk of mortality in children who achieve sustained ROSC after traumatic out-of-hospital cardiac arrest. Crit Care. 2019;23:101. doi: 10.1186/s13054-019-2391-z.
103.
Lin YR, Li CJ, Huang CC, Lee TH, Chen TY, Yang MC, Chou CC, Chang CF, Huang HW, Hsu HY, Chen WL. Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest. Front Pediatr. 2019;7:220. doi: 10.3389/fped.2019.00220.
104.
Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother. 2018;4:144–151. doi: 10.1093/ehjcvp/pvx023.
105.
Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Wessel DL, Jenkins TL, Notterman DA, Holubkov R, Tamburro RF, Dean JM, Nadkarni VM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators. Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation. 2018;137:1784–1795. doi: 10.1161/CIRCULATIONAHA.117.032270.
106.
Herman ST, Abend NS, Bleck TP, Chapman KE, Drislane FW, Emerson RG, Gerard EE, Hahn CD, Husain AM, Kaplan PW, LaRoche SM, Nuwer MR, Quigg M, Riviello JJ, Schmitt SE, Simmons LA, Tsuchida TN, Hirsch LJ; Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32:87–95. doi: 10.1097/WNP.0000000000000166.
107.
Abend NS, Topjian A, Ichord R, Herman ST, Helfaer M, Donnelly M, Nadkarni V, Dlugos DJ, Clancy RR. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72:1931–1940. doi: 10.1212/WNL.0b013e3181a82687.
108.
Topjian AA, Gutierrez-Colina AM, Sanchez SM, Berg RA, Friess SH, Dlugos DJ, Abend NS. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med. 2013;41:215–223. doi: 10.1097/CCM.0b013e3182668035.
109.
Ostendorf AP, Hartman ME, Friess SH. Early Electroencephalographic Findings Correlate With Neurologic Outcome in Children Following Cardiac Arrest. Pediatr Crit Care Med. 2016;17:667–676. doi: 10.1097/PCC.0000000000000791.
110.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello JJ, Shutter L, Sperling MR, Treiman DM, Vespa PM; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23. doi: 10.1007/s12028-012-9695-z.
111.
Topjian AA, Sánchez SM, Shults J, Berg RA, Dlugos DJ, Abend NS. Early Electroencephalographic Background Features Predict Outcomes in Children Resuscitated From Cardiac Arrest. Pediatr Crit Care Med. 2016;17:547–557. doi: 10.1097/PCC.0000000000000740.
112.
Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Clark AE, Browning B, Pemberton VL, Page K, Shankaran S, Hutchison JS, Newth CJ, Bennett KS, Berger JT, Topjian A, Pineda JA, Koch JD, Schleien CL, Dalton HJ, Ofori-Amanfo G, Goodman DM, Fink EL, McQuillen P, Zimmerman JJ, Thomas NJ, van der Jagt EW, Porter MB, Meyer MT, Harrison R, Pham N, Schwarz AJ, Nowak JE, Alten J, Wheeler DS, Bhalala US, Lidsky K, Lloyd E, Mathur M, Shah S, Wu T, Theodorou AA, Sanders RC, Dean JM; THAPCA Trial Investigators. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372:1898–1908. doi: 10.1056/NEJMoa1411480.
113.
Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Browning B, Pemberton VL, Page K, et al; on behalf of the THAPCA Trial Investigators. Therapeutic hypothermia after in-hospital cardiac arrest in children. N Engl J Med. 2017;376:318–329. doi: 10.1056/NEJMoa1610493.
114.
Slomine BS, Silverstein FS, Page K, Holubkov R, Christensen JR, Dean JM, Moler FW; Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Relationships between three and twelve month outcomes in children enrolled in the therapeutic hypothermia after pediatric cardiac arrest trials. Resuscitation. 2019;139:329–336. doi: 10.1016/j.resuscitation.2019.03.020.
115.
Slomine BS, Silverstein FS, Christensen JR, Holubkov R, Telford R, Dean JM, Moler FW; Therapeutic Hypothermia after Paediatric Cardiac Arrest (THAPCA) Trial Investigators. Neurobehavioural outcomes in children after In-Hospital cardiac arrest. Resuscitation. 2018;124:80–89. doi: 10.1016/j.resuscitation.2018.01.002.
116.
Slomine BS, Silverstein FS, Christensen JR, Page K, Holubkov R, Dean JM, Moler FW. Neuropsychological Outcomes of Children 1 Year After Pediatric Cardiac Arrest: Secondary Analysis of 2 Randomized Clinical Trials. JAMA Neurol. 2018;75:1502–1510. doi: 10.1001/jamaneurol.2018.2628.
117.
Slomine BS, Silverstein FS, Christensen JR, Holubkov R, Page K, Dean JM, Moler FW; on behalf of the THAPCA Trial Group. Neurobehavioral outcomes in children after out-of-hospital cardiac arrest. Pediatrics. 2016;137:e20153412. doi: 10.1542/peds.2015–3412.
118.
van Zellem L, Buysse C, Madderom M, Legerstee JS, Aarsen F, Tibboel D, Utens EM. Long-term neuropsychological outcomes in children and adolescents after cardiac arrest. Intensive Care Med. 2015;41:1057–1066. doi: 10.1007/s00134-015-3789-y.
119.
van Zellem L, Utens EM, Legerstee JS, Cransberg K, Hulst JM, Tibboel D, Buysse C. Cardiac Arrest in Children: Long-Term Health Status and Health-Related Quality of Life. Pediatr Crit Care Med. 2015;16:693–702. doi: 10.1097/PCC.0000000000000452.
120.
van Zellem L, Utens EM, Madderom M, Legerstee JS, Aarsen F, Tibboel D, Buysse C. Cardiac arrest in infants, children, and adolescents: long-term emotional and behavioral functioning. Eur J Pediatr. 2016;175:977–986. doi: 10.1007/s00431-016-2728-4.
121.
Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng K-C, et al. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in children: an advisory statement from the International Liaison Committee on Resuscitation. Circulation. 2020;142:e000–e000. doi: 10.1161/CIR.0000000000000911
122.
Topjian AA, de Caen A, Wainwright MS, Abella BS, Abend NS, Atkins DL, Bembea MM, Fink EL, Guerguerian AM, Haskell SE, Kilgannon JH, Lasa JJ, Hazinski MF. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation. 2019;140:e194–e233. doi: 10.1161/CIR.0000000000000697.
123.
Inwald DP, Canter R, Woolfall K, Mouncey P, Zenasni Z, O’Hara C, Carter A, Jones N, Lyttle MD, Nadel S, et al; on behalf of PERUKI (Paediatric Emergency Research in the UK and Ireland) and PICS SG (Paediatric Intensive Care Society Study Group). Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial. Archives of disease in childhood. 2019;104:426–431. doi: 10.1136/archdischild-2018–314924.
124.
van Paridon BM, Sheppard C, Garcia Guerra G, Joffe AR; on behalf of the Alberta Sepsis Network. Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care. Crit Care. 2015;19:293. doi: 10.1186/s13054-015-1010-x.
125.
Sankar J, Ismail J, Sankar MJ, C P S, Meena RS. Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial. Pediatr Crit Care Med. 2017;18:e435–e445. doi: 10.1097/PCC.0000000000001269.
126.
Medeiros DN, Ferranti JF, Delgado AF, de Carvalho WB. Colloids for the Initial Management of Severe Sepsis and Septic Shock in Pediatric Patients: A Systematic Review. Pediatr Emerg Care. 2015;31:e11–e16. doi: 10.1097/PEC.0000000000000601.
127.
Balamuth F, Kittick M, McBride P, Woodford AL, Vestal N, Casper TC, Metheney M, Smith K, Atkin NJ, Baren JM, Dean JM, Kuppermann N, Weiss SL. Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis: The PRoMPT BOLUS Randomized Controlled Trial Pilot Feasibility Study. Acad Emerg Med. 2019;26:1346–1356. doi: 10.1111/acem.13815.
128.
Weiss SL, Keele L, Balamuth F, Vendetti N, Ross R, Fitzgerald JC, Gerber JS. Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study. J Pediatr. 2017;182:304–310.e10. doi: 10.1016/j.jpeds.2016.11.075.
129.
Emrath ET, Fortenberry JD, Travers C, McCracken CE, Hebbar KB. Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis. Crit Care Med. 2017;45:1177–1183. doi: 10.1097/CCM.0000000000002365.
130.
Ventura AM, Shieh HH, Bousso A, Góes PF, de Cássia F O Fernandes I, de Souza DC, Paulo RL, Chagas F, Gilio AE. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med. 2015;43:2292–2302. doi: 10.1097/CCM.0000000000001260.
131.
Ramaswamy KN, Singhi S, Jayashree M, Bansal A, Nallasamy K. Double-Blind Randomized Clinical Trial Comparing Dopamine and Epinephrine in Pediatric Fluid-Refractory Hypotensive Septic Shock. Pediatr Crit Care Med. 2016;17:e502–e512. doi: 10.1097/PCC.0000000000000954.
132.
Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, Okhuysen-Cawley RS, Relvas MS, Rozenfeld RA, Skippen PW, Stojadinovic BJ, Williams EA, Yeh TS, Balamuth F, Brierley J, de Caen AR, Cheifetz IM, Choong K, Conway E, Cornell T, Doctor A, Dugas MA, Feldman JD, Fitzgerald JC, Flori HR, Fortenberry JD, Graciano AL, Greenwald BM, Hall MW, Han YY, Hernan LJ, Irazuzta JE, Iselin E, van der Jagt EW, Jeffries HE, Kache S, Katyal C, Kissoon N, Kon AA, Kutko MC, MacLaren G, Maul T, Mehta R, Odetola F, Parbuoni K, Paul R, Peters MJ, Ranjit S, Reuter-Rice KE, Schnitzler EJ, Scott HF, Torres A, Weingarten-Arams J, Weiss SL, Zimmerman JJ, Zuckerberg AL. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017;45:1061–1093. doi: 10.1097/CCM.0000000000002425.
133.
Lampin ME, Rousseaux J, Botte A, Sadik A, Cremer R, Leclerc F. Noradrenaline use for septic shock in children: doses, routes of administration and complications. Acta Paediatr. 2012;101:e426–e430. doi: 10.1111/j.1651-2227.2012.02725.x.
134.
Deep A, Goonasekera CD, Wang Y, Brierley J. Evolution of haemodynamics and outcome of fluid-refractory septic shock in children. Intensive Care Med. 2013;39:1602–1609. doi: 10.1007/s00134-013-3003-z.
135.
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21:e52–e106. doi: 10.1097/PCC.0000000000002198.
136.
Kelly LK, Porta NF, Goodman DM, Carroll CL, Steinhorn RH. Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide. J Pediatr. 2002;141:830–832. doi: 10.1067/mpd.2002.129849.
137.
Kerr D, Kelly AM, Dietze P, Jolley D, Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction. 2009;104:2067–2074. doi: 10.1111/j.1360-0443.2009.02724.x.
138.
Wanger K, Brough L, Macmillan I, Goulding J, MacPhail I, Christenson JM. Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. Acad Emerg Med. 1998;5:293–299. doi: 10.1111/j.1553-2712.1998.tb02707.x.
139.
Barton ED, Colwell CB, Wolfe T, Fosnocht D, Gravitz C, Bryan T, Dunn W, Benson J, Bailey J. Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting. J Emerg Med. 2005;29:265–271. doi: 10.1016/j.jemermed.2005.03.007.
140.
Robertson TM, Hendey GW, Stroh G, Shalit M. Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose. Prehosp Emerg Care. 2009;13:512–515. doi: 10.1080/10903120903144866.
141.
Cetrullo C, Di Nino GF, Melloni C, Pieri C, Zanoni A. [Naloxone antagonism toward opiate analgesic drugs. Clinical experimental study]. Minerva Anestesiol. 1983;49:199–204.
142.
Osterwalder JJ. Naloxone–for intoxications with intravenous heroin and heroin mixtures–harmless or hazardous? A prospective clinical study. J Toxicol Clin Toxicol. 1996;34:409–416. doi: 10.3109/15563659609013811.
143.
Sporer KA, Firestone J, Isaacs SM. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med. 1996;3:660–667. doi: 10.1111/j.1553-2712.1996.tb03487.x.
144.
Stokland O, Hansen TB, Nilsen JE. [Prehospital treatment of heroin intoxication in Oslo in 1996]. Tidsskr Nor Laegeforen. 1998;118:3144–3146.
145.
Buajordet I, Naess AC, Jacobsen D, Brørs O. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med. 2004;11:19–23. doi: 10.1097/00063110-200402000-00004.
146.
Cantwell K, Dietze P, Flander L. The relationship between naloxone dose and key patient variables in the treatment of non-fatal heroin overdose in the prehospital setting. Resuscitation. 2005;65:315–319. doi: 10.1016/j.resuscitation.2004.12.012.
147.
Boyd JJ, Kuisma MJ, Alaspää AO, Vuori E, Repo JV, Randell TT. Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients. Acta Anaesthesiol Scand. 2006;50:1266–1270. doi: 10.1111/j.1399-6576.2006.01172.x.
148.
Nielsen K, Nielsen SL, Siersma V, Rasmussen LS. Treatment of opioid overdose in a physician-based prehospital EMS: frequency and long-term prognosis. Resuscitation. 2011;82:1410–1413. doi: 10.1016/j.resuscitation.2011.05.027.
149.
Wampler DA, Molina DK, McManus J, Laws P, Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehosp Emerg Care. 2011;15:320–324. doi: 10.3109/10903127.2011.569854.
150.
Kelly AM, Kerr D, Dietze P, Patrick I, Walker T, Koutsogiannis Z. Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. Med J Aust. 2005;182:24–27.
151.
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519. doi: 10.1002/14651858.CD003519.pub4.
152.
de Almeida, MF, Guinsburg, R, Velaphi, S, Aziz, K, Perlman, JM, Szyld, E, Kim, HS, Hosono, S, Liley, HG, Mildenhall, L, et al. Intravenous vs. intraosseus administration of drugs during cardiac arrest: International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force. 2019. https://costr.ilcor.org/document/intravenous-vs-intraosseous-administration-of-drugs-during-cardiac-arrest-nls-task-force-systematic-review-costr. Updated February 20, 2020. Accessed March 2, 2020.
153.
Foglia, EE, Weiner, G, de Almeida, MF, Liley, HG, Aziz, K, Fabres, J, Fawke, J, Hosono, S, Isayama, T, Kapadia, VS, et al. Impact of duration of intensive resuscitation (NLS #895): systematic review: International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force. 2020. https://costr.ilcor.org/document/impact-of-duration-of-intensive-resuscitation-nls-896-systematic-review. Updated February 19, 2020. Accessed March 1, 2020.
154.
Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F; American Heart Association Education Science Investigators; and on behalf of the American Heart Association Education Science and Programs Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2018;138:e82–e122. doi: 10.1161/CIR.0000000000000583.
155.
Anderson R, Sebaldt A, Lin Y, Cheng A. Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial. Resuscitation. 2019;135:153–161. doi: 10.1016/j.resuscitation.2018.10.033.
156.
Lin Y, Cheng A, Grant VJ, Currie GR, Hecker KG. Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers - A randomized controlled trial. Resuscitation. 2018;130:6–12. doi: 10.1016/j.resuscitation.2018.06.025.
157.
O’Donnell CM, Skinner AC. An evaluation of a short course in resuscitation training in a district general hospital. Resuscitation. 1993;26:193–201. doi: 10.1016/0300-9572(93)90179-t.
158.
Oermann MH, Kardong-Edgren SE, Odom-Maryon T. Effects of monthly practice on nursing students’ CPR psychomotor skill performance. Resuscitation. 2011;82:447–453. doi: 10.1016/j.resuscitation.2010.11.022.
159.
Kardong-Edgren S, Oermann MH, Odom-Maryon T. Findings from a nursing student CPR study: implications for staff development educators. J Nurses Staff Dev. 2012;28:9–15. doi: 10.1097/NND.0b013e318240a6ad.
160.
Nishiyama C, Iwami T, Murakami Y, Kitamura T, Okamoto Y, Marukawa S, Sakamoto T, Kawamura T. Effectiveness of simplified 15-min refresher BLS training program: a randomized controlled trial. Resuscitation. 2015;90:56–60. doi: 10.1016/j.resuscitation.2015.02.015.
161.
Sullivan NJ, Duval-Arnould J, Twilley M, Smith SP, Aksamit D, Boone-Guercio P, Jeffries PR, Hunt EA. Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial. Resuscitation. 2015;86:6–13. doi: 10.1016/j.resuscitation.2014.10.021.
162.
Patocka C, Cheng A, Sibbald M, Duff JP, Lai A, Lee-Nobbee P, Levin H, Varshney T, Weber B, Bhanji F. A randomized education trial of spaced versus massed instruction to improve acquisition and retention of paediatric resuscitation skills in emergency medical service (EMS) providers. Resuscitation. 2019;141:73–80. doi: 10.1016/j.resuscitation.2019.06.010.
163.
Patocka C, Khan F, Dubrovsky AS, Brody D, Bank I, Bhanji F. Pediatric resuscitation training-instruction all at once or spaced over time? Resuscitation. 2015;88:6–11. doi: 10.1016/j.resuscitation.2014.12.003.
164.
Kurosawa H, Ikeyama T, Achuff P, Perkel M, Watson C, Monachino A, Remy D, Deutsch E, Buchanan N, Anderson J, Berg RA, Nadkarni VM, Nishisaki A. A randomized, controlled trial of in situ pediatric advanced life support recertification (“pediatric advanced life support reconstructed”) compared with standard pediatric advanced life support recertification for ICU frontline providers*. Crit Care Med. 2014;42:610–618. doi: 10.1097/CCM.0000000000000024.
165.
Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(suppl):S70–81. doi: 10.1097/00001888-200410001-00022.
166.
McGaghie WC. When I say … mastery learning. Med Educ. 2015;49:558–559. doi: 10.1111/medu.12679.
167.
Magee MJ, Farkouh-Karoleski C, Rosen TS. Improvement of Immediate Performance in Neonatal Resuscitation Through Rapid Cycle Deliberate Practice Training. J Grad Med Educ. 2018;10:192–197. doi: 10.4300/JGME-D-17-00467.1.
168.
Diederich E, Lineberry M, Blomquist M, Schott V, Reilly C, Murray M, Nazaran P, Rourk M, Werner R, Broski J. Balancing Deliberate Practice and Reflection: A Randomized Comparison Trial of Instructional Designs for Simulation-Based Training in Cardiopulmonary Resuscitation Skills. Simul Healthc. 2019;14:175–181. doi: 10.1097/SIH.0000000000000375.
169.
Braun L, Sawyer T, Smith K, Hsu A, Behrens M, Chan D, Hutchinson J, Lu D, Singh R, Reyes J, Lopreiato J. Retention of pediatric resuscitation performance after a simulation-based mastery learning session: a multicenter randomized trial. Pediatr Crit Care Med. 2015;16:131–138. doi: 10.1097/PCC.0000000000000315.
170.
Cordero L, Hart BJ, Hardin R, Mahan JD, Nankervis CA. Deliberate practice improves pediatric residents’ skills and team behaviors during simulated neonatal resuscitation. Clin Pediatr (Phila). 2013;52:747–752. doi: 10.1177/0009922813488646.
171.
Hunt EA, Duval-Arnould JM, Chime NO, Jones K, Rosen M, Hollingsworth M, Aksamit D, Twilley M, Camacho C, Nogee DP, Jung J, Nelson-McMillan K, Shilkofski N, Perretta JS. Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study. Resuscitation. 2017;114:127–132. doi: 10.1016/j.resuscitation.2017.03.014.
172.
Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation. 2014;85:945–951. doi: 10.1016/j.resuscitation.2014.02.025.
173.
Jeffers J, Eppich W, Trainor J, Mobley B, Adler M. Development and Evaluation of a Learning Intervention Targeting First-Year Resident Defibrillation Skills. Pediatr Emerg Care. 2016;32:210–216. doi: 10.1097/PEC.0000000000000765.
174.
Reed T, Pirotte M, McHugh M, Oh L, Lovett S, Hoyt AE, Quinones D, Adams W, Gruener G, McGaghie WC. Simulation-Based Mastery Learning Improves Medical Student Performance and Retention of Core Clinical Skills. Simul Healthc. 2016;11:173–180. doi: 10.1097/SIH.0000000000000154.
175.
Kurup V, Matei V, Ray J. Role of in-situ simulation for training in healthcare: opportunities and challenges. Curr Opin Anaesthesiol. 2017;30:755–760. doi: 10.1097/ACO.0000000000000514.
176.
Goldshtein D, Krensky C, Doshi S, Perelman VS. In situ simulation and its effects on patient outcomes: a systematic review. BMJ Simulation and Technology Enhanced Learning. 2020;6:3–9. doi: 10.1136/bmjstel-2018-000387.
177.
Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: a systematic review. J Contin Educ Health Prof. 2012;32:243–254. doi: 10.1002/chp.21152.
178.
Steinemann S, Berg B, Skinner A, DiTulio A, Anzelon K, Terada K, Oliver C, Ho HC, Speck C. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ. 2011;68:472–477. doi: 10.1016/j.jsurg.2011.05.009.
179.
Clarke SO, Julie IM, Yao AP, Bang H, Barton JD, Alsomali SM, Kiefer MV, Al Khulaif AH, Aljahany M, Venugopal S, Bair AE. Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills. BMJ Simul Technol Enhanc Learn. 2019;5:29–33. doi: 10.1136/bmjstel-2017-000255.
180.
Rubio-Gurung S, Putet G, Touzet S, Gauthier-Moulinier H, Jordan I, Beissel A, Labaune JM, Blanc S, Amamra N, Balandras C, Rudigoz RC, Colin C, Picaud JC. In situ simulation training for neonatal resuscitation: an RCT. Pediatrics. 2014;134:e790–e797. doi: 10.1542/peds.2013-3988.
181.
Saqe-Rockoff A, Ciardiello AV, Schubert FD. Low-Fidelity, In-Situ Pediatric Resuscitation Simulation Improves RN Competence and Self-Efficacy. J Emerg Nurs. 2019;45:538–544.e1. doi: 10.1016/j.jen.2019.02.003.
182.
Katznelson JH, Wang J, Stevens MW, Mills WA. Improving Pediatric Preparedness in Critical Access Hospital Emergency Departments: Impact of a Longitudinal In Situ Simulation Program. Pediatr Emerg Care. 2018;34:17–20. doi: 10.1097/PEC.0000000000001366.
183.
Reder S, Cummings P, Quan L. Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students. Resuscitation. 2006;69:443–453. doi: 10.1016/j.resuscitation.2005.08.020.
184.
Roppolo LP, Pepe PE, Campbell L, Ohman K, Kulkarni H, Miller R, Idris A, Bean L, Bettes TN, Idris AH. Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study. Resuscitation. 2007;74:276–285. doi: 10.1016/j.resuscitation.2006.12.017.
185.
de Vries W, Turner NM, Monsieurs KG, Bierens JJ, Koster RW. Comparison of instructor-led automated external defibrillation training and three alternative DVD-based training methods. Resuscitation. 2010;81:1004–1009. doi: 10.1016/j.resuscitation.2010.04.006.
186.
Saraç L, Ok A. The effects of different instructional methods on students’ acquisition and retention of cardiopulmonary resuscitation skills. Resuscitation. 2010;81:555–561. doi: 10.1016/j.resuscitation.2009.08.030.
187.
Zeleke BG, Biswas ES, Biswas M. Teaching Cardiopulmonary Resuscitation to Young Children (<12 Years Old). Am J Cardiol. 2019;123:1626–1627. doi: 10.1016/j.amjcard.2019.02.011.
188.
Schmid KM, García RQ, Fernandez MM, Mould-Millman NK, Lowenstein SR. Teaching Hands-Only CPR in Schools: A Program Evaluation in San José, Costa Rica. Ann Glob Health. 2018;84:612–617. doi: 10.9204/aogh.2367.
189.
Li H, Shen X, Xu X, Wang Y, Chu L, Zhao J, Wang Y, Wang H, Xie G, Cheng B, et al. Bystander cardiopulmonary resuscitation training in primary and secondary school children in China and the impact of neighborhood socioeconomic status: A prospective controlled trial. Medicine (Baltimore). 2018;97:e12673. doi: 10.1097/MD.0000000000012673.
190.
Paglino M, Contri E, Baggiani M, Tonani M, Costantini G, Bonomo MC, Baldi E. A video-based training to effectively teach CPR with long-term retention: the ScuolaSalvaVita.it (“SchoolSavesLives.it”) project. Intern Emerg Med. 2019;14:275–279. doi: 10.1007/s11739-018-1946-3.
191.
Magid KH, Heard D, Sasson C. Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands-Only Cardiopulmonary Resuscitation. J Sch Health. 2018;88:524–530. doi: 10.1111/josh.12634.
192.
Andrews T, Price L, Mills B, Holmes L. Young adults’ perception of mandatory CPR training in Australian high schools: a qualitative investigation. Austr J Paramedicine. 2018;15. doi: 10.33151/ajp.15.2.577.
193.
Aloush S, Tubaishat A, ALBashtawy M, Suliman M, Alrimawi I, Al Sabah A, Banikhaled Y. Effectiveness of Basic Life Support Training for Middle School Students. J Sch Nurs. 2019;35:262–267. doi: 10.1177/1059840517753879.
194.
Gabriel IO, Aluko JO. Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students. World J Emerg Med. 2019;10:81–87. doi: 10.5847/wjem.j.1920-8642.2019.02.003.
195.
Brown LE, Carroll T, Lynes C, Tripathi A, Halperin H, Dillon WC. CPR skill retention in 795 high school students following a 45-minute course with psychomotor practice. Am J Emerg Med. 2018;36:1110–1112. doi: 10.1016/j.ajem.2017.10.026.
196.
Brookoff D, Kellermann AL, Hackman BB, Somes G, Dobyns P. Do blacks get bystander cardiopulmonary resuscitation as often as whites? Ann Emerg Med. 1994;24:1147–1150. doi: 10.1016/s0196-0644(94)70246-2.
197.
Vadeboncoeur TF, Richman PB, Darkoh M, Chikani V, Clark L, Bobrow BJ. Bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in the Hispanic vs the non-Hispanic populations. Am J Emerg Med. 2008;26:655–660. doi: 10.1016/j.ajem.2007.10.002.
198.
Anderson ML, Cox M, Al-Khatib SM, Nichol G, Thomas KL, Chan PS, Saha-Chaudhuri P, Fosbol EL, Eigel B, Clendenen B, Peterson ED. Rates of cardiopulmonary resuscitation training in the United States. JAMA Intern Med. 2014;174:194–201. doi: 10.1001/jamainternmed.2013.11320.
199.
Fosbøl EL, Dupre ME, Strauss B, Swanson DR, Myers B, McNally BF, Anderson ML, Bagai A, Monk L, Garvey JL, Bitner M, Jollis JG, Granger CB. Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention. Resuscitation. 2014;85:1512–1517. doi: 10.1016/j.resuscitation.2014.08.013.
200.
Blewer AL, Schmicker RH, Morrison LJ, Aufderheide TP, Daya M, Starks MA, May S, Idris AH, Callaway CW, Kudenchuk PJ, Vilke GM, Abella BS; Resuscitation Outcomes Consortium Investigators. Variation in Bystander Cardiopulmonary Resuscitation Delivery and Subsequent Survival From Out-of-Hospital Cardiac Arrest Based on Neighborhood-Level Ethnic Characteristics. Circulation. 2020;141:34–41. doi: 10.1161/CIRCULATIONAHA.119.041541.
201.
Mitchell MJ, Stubbs BA, Eisenberg MS. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation. Prehosp Emerg Care. 2009;13:478–486. doi: 10.1080/10903120903144833.
202.
Vaillancourt C, Lui A, De Maio VJ, Wells GA, Stiell IG. Socioeconomic status influences bystander CPR and survival rates for out-of-hospital cardiac arrest victims. Resuscitation. 2008;79:417–423. doi: 10.1016/j.resuscitation.2008.07.012.
203.
Chiang WC, Ko PC, Chang AM, Chen WT, Liu SS, Huang YS, Chen SY, Lin CH, Cheng MT, Chong KM, Wang HC, Yang CW, Liao MW, Wang CH, Chien YC, Lin CH, Liu YP, Lee BC, Chien KL, Lai MS, Ma MH. Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter? Resuscitation. 2014;85:53–58. doi: 10.1016/j.resuscitation.2013.07.033.
204.
Moncur L, Ainsborough N, Ghose R, Kendal SP, Salvatori M, Wright J. Does the level of socioeconomic deprivation at the location of cardiac arrest in an English region influence the likelihood of receiving bystander-initiated cardiopulmonary resuscitation? Emerg Med J. 2016;33:105–108. doi: 10.1136/emermed-2015-204643.
205.
Dahan B, Jabre P, Karam N, Misslin R, Tafflet M, Bougouin W, Jost D, Beganton F, Marijon E, Jouven X. Impact of neighbourhood socio-economic status on bystander cardiopulmonary resuscitation in Paris. Resuscitation. 2017;110:107–113. doi: 10.1016/j.resuscitation.2016.10.028.
206.
Brown TP, Booth S, Hawkes CA, Soar J, Mark J, Mapstone J, Fothergill RT, Black S, Pocock H, Bichmann A, Gunson I, Perkins GD. Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England. Eur Heart J Qual Care Clin Outcomes. 2019;5:51–62. doi: 10.1093/ehjqcco/qcy026.
207.
Liu KY, Haukoos JS, Sasson C. Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet. Resuscitation. 2014;85:131–137. doi: 10.1016/j.resuscitation.2013.08.274.
208.
Yip MP, Ong B, Tu SP, Chavez D, Ike B, Painter I, Lam I, Bradley SM, Coronado GD, Meischke HW. Diffusion of cardiopulmonary resuscitation training to chinese immigrants with limited english proficiency. Emerg Med Int. 2011;2011:685249. doi: 10.1155/2011/685249.
209.
Meischke H, Taylor V, Calhoun R, Liu Q, Sos C, Tu SP, Yip MP, Eisenberg D. Preparedness for cardiac emergencies among Cambodians with limited English proficiency. J Community Health. 2012;37:176–180. doi: 10.1007/s10900-011-9433-z.
210.
Sasson C, Haukoos JS, Bond C, Rabe M, Colbert SH, King R, Sayre M, Heisler M. Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH. Circ Cardiovasc Qual Outcomes. 2013;6:550–558. doi: 10.1161/CIRCOUTCOMES.111.000097.
211.
Sasson C, Haukoos JS, Ben-Youssef L, Ramirez L, Bull S, Eigel B, Magid DJ, Padilla R. Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado. Ann Emerg Med. 2015;65:545–552.e2. doi: 10.1016/j.annemergmed.2014.10.028.
212.
Blewer AL, Ibrahim SA, Leary M, Dutwin D, McNally B, Anderson ML, Morrison LJ, Aufderheide TP, Daya M, Idris AH, et al. Cardiopulmonary resuscitation training disparities in the United States. J Am Heart Assoc. 2017;6:e006124. doi: 10.1161/JAHA.117.006124.
213.
Abdulhay NM, Totolos K, McGovern S, Hewitt N, Bhardwaj A, Buckler DG, Leary M, Abella BS. Socioeconomic disparities in layperson CPR training within a large U.S. city. Resuscitation. 2019;141:13–18. doi: 10.1016/j.resuscitation.2019.05.038.
214.
Sasson C, Keirns CC, Smith DM, Sayre MR, Macy ML, Meurer WJ, McNally BF, Kellermann AL, Iwashyna TJ. Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation. Resuscitation. 2011;82:674–679. doi: 10.1016/j.resuscitation.2011.02.002.
215.
Root ED, Gonzales L, Persse DE, Hinchey PR, McNally B, Sasson C. A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston. Resuscitation. 2013;84:752–759. doi: 10.1016/j.resuscitation.2013.01.007.
216.
Becker TK, Gul SS, Cohen SA, Maciel CB, Baron-Lee J, Murphy TW, Youn TS, Tyndall JA, Gibbons C, Hart L, Alviar CL; Florida Cardiac Arrest Resource Team. Public perception towards bystander cardiopulmonary resuscitation. Emerg Med J. 2019;36:660–665. doi: 10.1136/emermed-2018-208234.
217.
Perman SM, Shelton SK, Knoepke C, Rappaport K, Matlock DD, Adelgais K, Havranek EP, Daugherty SL. Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest. Circulation. 2019;139:1060–1068. doi: 10.1161/CIRCULATIONAHA.118.037692.
218.
Blewer AL, McGovern SK, Schmicker RH, May S, Morrison LJ, Aufderheide TP, Daya M, Idris AH, Callaway CW, Kudenchuk PJ, Vilke GM, Abella BS; Resuscitation Outcomes Consortium (ROC) Investigators. Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public. Circ Cardiovasc Qual Outcomes. 2018;11:e004710. doi: 10.1161/CIRCOUTCOMES.118.004710.
219.
Kramer CE, Wilkins MS, Davies JM, Caird JK, Hallihan GM. Does the sex of a simulated patient affect CPR? Resuscitation. 2015;86:82–87. doi: 10.1016/j.resuscitation.2014.10.016.
220.
Camp BN, Parish DC, Andrews RH. Effect of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital. Ann Emerg Med. 1997;29:529–533. doi: 10.1016/s0196-0644(97)70228-2.
221.
Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. In-hospital resuscitation: association between ACLS training and survival to discharge. Resuscitation. 2000;47:83–87. doi: 10.1016/s0300-9572(00)00210-0.
222.
Lowenstein SR, Sabyan EM, Lassen CF, Kern DC. Benefits of training physicians in advanced cardiac life support. Chest. 1986;89:512–516. doi: 10.1378/chest.89.4.512.
223.
Makker R, Gray-Siracusa K, Evers M. Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests. Heart Lung. 1995;24:116–120. doi: 10.1016/s0147-9563(05)80005-6.
224.
Moretti MA, Cesar LA, Nusbacher A, Kern KB, Timerman S, Ramires JA. Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation. 2007;72:458–465. doi: 10.1016/j.resuscitation.2006.06.039.
225.
Pottle A, Brant S. Does resuscitation training affect outcome from cardiac arrest? Accid Emerg Nurs. 2000;8:46–51. doi: 10.1054/aaen.1999.0089.
226.
Sanders AB, Berg RA, Burress M, Genova RT, Kern KB, Ewy GA. The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med. 1994;23:56–59. doi: 10.1016/s0196-0644(94)70009-5.
227.
Sodhi K, Singla MK, Shrivastava A. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med. 2011;15:209–212. doi: 10.4103/0972-5229.92070.
228.
Lockey A, Lin Y, Cheng A. Impact of adult advanced cardiac life support course participation on patient outcomes-A systematic review and meta-analysis. Resuscitation. 2018;129:48–54. doi: 10.1016/j.resuscitation.2018.05.034.
229.
Girotra S, van Diepen S, Nallamothu BK, Carrel M, Vellano K, Anderson ML, McNally B, Abella BS, Sasson C, Chan PS; CARES Surveillance Group and the HeartRescue Project. Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States. Circulation. 2016;133:2159–2168. doi: 10.1161/CIRCULATIONAHA.115.018175.
230.
Zijlstra JA, Stieglis R, Riedijk F, Smeekes M, van der Worp WE, Koster RW. Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system. Resuscitation. 2014;85:1444–1449. doi: 10.1016/j.resuscitation.2014.07.020.
231.
Berglund E, Claesson A, Nordberg P, Djärv T, Lundgren P, Folke F, Forsberg S, Riva G, Ringh M. A smartphone application for dispatch of lay responders to out-of-hospital cardiac arrests. Resuscitation. 2018;126:160–165. doi: 10.1016/j.resuscitation.2018.01.039.
232.
Fletcher KA, Bedwell WL. Cognitive aids: design suggestions for the medical field. Proc Int Symp Human Factors Ergonomics Health Care. 2014;3:148–152. doi: 10.1177/2327857914031024.
233.
Fitzgerald M, Cameron P, Mackenzie C, Farrow N, Scicluna P, Gocentas R, Bystrzycki A, Lee G, O’Reilly G, Andrianopoulos N, Dziukas L, Cooper DJ, Silvers A, Mori A, Murray A, Smith S, Xiao Y, Stub D, McDermott FT, Rosenfeld JV. Trauma resuscitation errors and computer-assisted decision support. Arch Surg. 2011;146:218–225. doi: 10.1001/archsurg.2010.333.
234.
Bernhard M, Becker TK, Nowe T, Mohorovicic M, Sikinger M, Brenner T, Richter GM, Radeleff B, Meeder PJ, Büchler MW, Böttiger BW, Martin E, Gries A. Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room. Resuscitation. 2007;73:362–373. doi: 10.1016/j.resuscitation.2006.09.014.
235.
Kelleher DC, Carter EA, Waterhouse LJ, Parsons SE, Fritzeen JL, Burd RS. Effect of a checklist on advanced trauma life support task performance during pediatric trauma resuscitation. Acad Emerg Med. 2014;21:1129–1134. doi: 10.1111/acem.12487.
236.
Lashoher A, Schneider EB, Juillard C, Stevens K, Colantuoni E, Berry WR, Bloem C, Chadbunchachai W, Dharap S, Dy SM, Dziekan G, Gruen RL, Henry JA, Huwer C, Joshipura M, Kelley E, Krug E, Kumar V, Kyamanywa P, Mefire AC, Musafir M, Nathens AB, Ngendahayo E, Nguyen TS, Roy N, Pronovost PJ, Khan IQ, Razzak JA, Rubiano AM, Turner JA, Varghese M, Zakirova R, Mock C. Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures. World J Surg. 2017;41:954–962. doi: 10.1007/s00268-016-3759-8.

eLetters(0)

eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.

Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.

Information & Authors

Information

Published In

Versions

You are viewing the most recent version of this article.

History

Published in print: 20 October 2020
Published online: 21 October 2020

Permissions

Request permissions for this article.

Keywords

  1. AHA Scientific Statements
  2. apnea
  3. automated external defibrillator
  4. capnography
  5. cardiopulmonary resuscitation
  6. defibrillators
  7. delivery of health care
  8. echocardiography
  9. electric countershock
  10. epinephrine
  11. extracorporeal membrane oxygenation
  12. heart arrest
  13. infusions, intraosseous
  14. intubation, intratracheal
  15. life support care
  16. respiration, artificial
  17. shock, cardiogenic
  18. shock, septic

Subjects

Authors

Affiliations

Raina M. Merchant, MD, MSHP
Alexis A. Topjian, MD, MSCE
Ashish R. Panchal, MD, PhD
Khalid Aziz, MBBS, MA, MEd(IT)
Eric J. Lavonas, MD, MS
David J. Magid, MD, MPH
On behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups

Disclosures

Writing Group Disclosures
Writing Group MemberEmploymentResearch GrantOther Research SupportSpeakers’ Bureau/HonorariaExpert WitnessOwnership InterestConsultant/Advisory BoardOther
Raina M. MerchantUniversity of PennsylvaniaNIH (R01 PI not specific to cardiac arrest: “Digital Phenotyping and Cardiovascular Health”)*NoneNoneNoneNoneNoneNone
Khalid AzizUniversity of Alberta (Canada)NoneNoneNoneNoneNoneNoneNone
Katherine M. BergBeth Israel Deaconess Medical CenterNHLBI Grant K23 HL128814NoneNoneNoneNoneNoneNone
Adam ChengAlberta Children’s Hospital (Canada)NoneNoneNoneNoneNoneNoneNone
Eric J. LavonasDenver Health Emergency MedicineBTG Pharmaceuticals (Denver Health (Dr Lavonas’ employer) has research, call center, consulting, and teaching agreements with BTG Pharmaceuticals. BTG manufactures the digoxin antidote, DigiFab. Dr Lavonas does not receive bonus or incentive compensation, and these agreements involve an unrelated product. When these guidelines were developed, Dr Lavonas recused from discussions related to digoxin poisoning.)NoneNoneNoneNoneNoneAmerican Heart Association (Senior Science Editor)
David J. MagidUniversity of ColoradoNIH; NHLBI; CMS; AHANoneNoneNoneNoneNoneAmerican Heart Association (Senior Science Editor)
Ashish R. PanchalThe Ohio State UniversityNoneNoneNoneNoneNoneNoneNone
Alexis A. TopjianThe Children’s Hospital of Philadelphia, University of PennsylvaniaNIH*NoneNoneNoneNoneNoneNone
This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.
*
Modest.
Significant.
Reviewer Disclosures
ReviewerEmploymentResearch GrantOther Research SupportSpeakers’ Bureau/HonorariaExpert WitnessOwnership InterestConsultant/Advisory BoardOther
Aarti BavareBaylor College of MedicineNoneNoneNoneNoneNoneNoneNone
Raúl J. GazmuriRosalind Franklin University of Medicine and ScienceZoll Foundation (received–Myocardial Effects of Shock Burden During Defibrillation Attempts. Work conducted in a swine model); Zoll Foundation (received–Amplitude Spectral Area to Assess Hemodynamic and Metabolic Interventions during Cardiac Arrest. Work conducted in a swine model); Zoll Foundation (Does Erythropoietin Reduce Adverse Post-Resuscitation Myocardial and Cerebral Effects of Epinephrine Resulting in Improved Survival with Good Neurological Function? Work in a swine model)NoneNoneNoneNoneNoneNone
Julia IndikUniversity of ArizonaNoneNoneNoneNoneNoneNoneNone
Steven L. KronickUniversity of MichiganNIH (Enhancing Pre-Hospital Outcomes for Cardiac Arrest [EPOC])*NoneNoneNoneNoneNoneNone
Eddy LangUniversity of Calgary (Canada)NoneNoneNoneNoneNoneNoneNone
Alexandra MarquezChildren’s Hospital of PhiladelphiaLabatt Innovation Fund (seed fund grant (≈25K) for device development project to create a “rapid access” ECLS cannulation deployment system)NoneNoneNoneNoneNoneNone
Mary Ann McNeilUniversity of MinnesotaNoneNoneNoneNoneNoneNoneNone
Robert D. NelsonWake Forest University Health SciencesNoneNoneNoneNoneNoneNoneNone
Donald H. ShaffnerJohns Hopkins HospitalNoneNoneNoneNoneNoneNoneNone
This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.
*
Modest.
Significant.

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

  1. Reanimation, FAQ Klinische Akut- und Notfallmedizin, (63-76), (2025).https://doi.org/10.1016/B978-3-437-21039-6.00003-1
    Crossref
  2. Impact of Simulation on the Development of Nursing Students' Competence in Adult Cardiopulmonary Resuscitation, Cureus, (2024).https://doi.org/10.7759/cureus.72722
    Crossref
  3. Challenges, Innovations, and Training in Airway Management During Cardiopulmonary Resuscitation: A Narrative Review, Cureus, (2024).https://doi.org/10.7759/cureus.71686
    Crossref
  4. Percutaneous Coronary Intervention (PCI) Post Out-of-Hospital Cardiac Arrest: A Narrative Review, Cureus, (2024).https://doi.org/10.7759/cureus.71420
    Crossref
  5. YouTube as a source of information in cardiopulmonary resuscitation for 2020 AHA Resuscitation Guidelines, PeerJ, 12, (e18344), (2024).https://doi.org/10.7717/peerj.18344
    Crossref
  6. Comparison of quality of chest compression in different postures using female patient manikin, The Journal of Physical Fitness and Sports Medicine, 13, 5, (157-161), (2024).https://doi.org/10.7600/jpfsm.13.157
    Crossref
  7. Basic Life Support in Earthquake with Simulation Supported Training, Yoğun Bakım Hemşireliği Dergisi, 28, 2, (126-132), (2024).https://doi.org/10.62111/ybhd.1470833
    Crossref
  8. Early endotracheal intubation is not associated with the rate of return of spontaneous circulation following cardiac arrest at the emergency department: an exploratory analysis, World Journal of Emergency Medicine, 15, 4, (297), (2024).https://doi.org/10.5847/wjem.j.1920-8642.2024.050
    Crossref
  9. Characteristics of the out-of-hospital cardiac arrest attended by the medical emergency services in Medellín. A population-based retrospective cohort studyCaracterísticas del paro cardiaco extrahospitalario atendido por operadores de ambulancias en Medellín. Estudio de cohorte retrospectivo de base poblacional, Colombian Journal of Anesthesiology, 52, 2, (2024).https://doi.org/10.5554/22562087.e1102
    Crossref
  10. Okul Çağındaki Çocuklara Kardiyopulmoner Resusitasyon Öğretilebilir: Çocuklar Hayat Kurtarır, Anatolian Journal of Emergency Medicine, 7, 1, (47-53), (2024).https://doi.org/10.54996/anatolianjem.1437152
    Crossref
  11. See more
Loading...

View Options

View options

PDF and All Supplements

Download PDF and All Supplements

PDF/EPUB

View PDF/EPUB
Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to access the full text.

Purchase access to this article for 24 hours

Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Circulation
  • Vol. 142
  • No. 16_suppl_2

Purchase access to this journal for 24 hours

Circulation
  • Vol. 142
  • No. 16_suppl_2
Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Figures

Other

Tables

Share

Share

Share article link

Share

Comment Response