From Science to Guidelines: The Future for Resuscitation

The periodic development and publication of treatment guidelines is integral to the field of cardiopulmonary resuscitationand emergency cardiovascular care. The methods for guideline development have evolved over the past few decades, andthe process itself has become the subject of increasing scientific investigation. An internationally validated tool for assessingthe quality of clinical practice guidelines is The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Applying this tool to the ILCOR 2010 International Consensus on CPR (cardiopulmonary resuscitation) and ECC (emergencycardiac care) Science with Treatment Recommendations (CoSTR) and the resulting member council guidelines will be avaluable initial step in evaluating both the process and the product. By doing so, important strengths can be recognizedas well as opportunities for improvement moving forward. Beyond validated tools to assess and improve the quality of thetraditional guidelines process, a critical reassessment of the overall strategy for improving cardiac arrest outcomes is indicated.From the lay-provider perspective, innovative approaches to facilitate performance of bystander CPR are needed.This is likely to entail more individualized instructional methods that are titrated to the provider’s capabilities for learningand performance. What the future might hold for professional providers is a more individualized treatment strategy titratedto real-time physiologic monitoring with mechanized delivery of therapies guided by real-time computer-aided medicaldecision-making. These individualized instructional and treatment strategies could revolutionize our approach to cardiacarrest resuscitation, and dramatically change how guidelines are developed, implemented and evaluated.