Table 6.

ALS Topics Reviewed by EvUps

Topic/PICO	Year(s) last updated	Existing treatment recommendation	Relevant studies since last review, n	Sufficient data to warrant SysRev?
Transition from nonshockable to shockable rhythm (ALS 444)	2010 CoSTR	None	No studies	No
Oxygen dose during CPR (ALS 889)	2015 CoSTR; 2020 EvUp	We suggest using the highest possible inspired oxygen concentration during CPR (weak recommendation, very low–certainty evidence).	No studies	No
Steroids during CPR (ALS 433)	2015 CoSTR; 2020 EvUp	For IHCA, the task force was unable to reach a consensus recommendation for or against the use of steroids during cardiac arrest. We suggest against the routine use of steroids during CPR for OHCA (weak recommendation, very low–certainty evidence).	2 SysRevs, 3 RCTs registered with trial registries yet to report	Consider after publication of ongoing RCTs
Confirmation of correct tracheal tube position (ALS 469)	2015 CoSTR	We recommend using waveform capnography to confirm and continuously monitor the position of a tracheal tube during CPR in addition to clinical assessment (strong recommendation, low–quality evidence).	1 SysRev, 2 observational studies	No
Automatic ventilators vs manual ventilation during CPR (ALS 490)	2010 CoSTR	There is insufficient evidence to support or refute the use of an automatic transport ventilator over manual ventilation during resuscitation of the patient with cardiac arrest with an advanced airway.	2 RCTs (simulation studies), 2 observational studies	No
Cardiac arrest caused by asthma (ALS 492)	2010 CoSTR	There is insufficient evidence to suggest any routine change to cardiac arrest resuscitation treatment algorithms for patients with cardiac arrest caused by asthma.	1 observational study	No
ECPR vs manual or mechanical CPR (ALS 723)	2019 CoSTR	We suggest that ECPR may be considered as a rescue therapy for selected patients with cardiac arrest when conventional CPR is failing in settings in which it can be implemented (weak recommendation, very low–certainty evidence).	1 RCT	No
Postresuscitation steroids (ALS 446)	2010 CoSTR; 2020 EvUp	There is insufficient evidence to support or refute the use of corticosteroids alone or in combination with other drugs after cardiac arrest.	1 SysRev, 1 RCT not yet reported, 2 further RCTs ongoing	Consider after publication of ongoing RCTs
Oxygen dose after ROSC in adults (ALS 448)	2020 CoSTR	We recommend avoiding hypoxemia in adults with ROSC after cardiac arrest in any setting (strong recommendation, very low–certainty evidence). We suggest avoiding hyperoxemia in adults with ROSC after cardiac arrest in any setting (weak recommendation, low-certainty evidence).	1 SysRev, 1 RCT subgroup analysis, 12 observational studies	Consider after publication of ongoing RCTs
Neuroprognostication after ROSC (ALS 450, 458, 460, 484, 487, 713)	2020 CoSTR	We recommend that neuroprognostication always be undertaken with a multimodal approach because no single test has sufficient specificity to eliminate false positives (strong recommendation, very low–certainty evidence). Clinical examination: We suggest using PLR at ≥72 h after ROSC for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). We suggest using quantitative pupillometry at ≥72 h after ROSC for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, low–certainty evidence).We suggest using bilateral absence of corneal reflex at ≥72 h after ROSC for predicting poor neurological outcome in adults who are comatose after cardiac arrest (weak recommendation, very low-certainty evidence).We suggest using presence of myoclonus or status myoclonus within 7 d after ROSC, in combination with other tests, for predicting poor neurological outcome in adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). We also suggest recording EEG in the presence of myoclonic jerks to detect any associated epileptiform activity (weak recommendation, very low–certainty evidence). Electrophysiology: We suggest using a bilaterally absent N20 wave of SSEP in combination with other indices to predict poor outcome in adult patients who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). We suggest against using the absence of EEG background reactivity alone to predict poor outcome in adult patients who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). We suggest using the presence of seizure activity on EEG in combination with other indices to predict poor outcome in adult patients who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence).	1 SysRev, 10 observational studies	No
		We suggest using burst suppression on EEG in combination with other indices to predict poor outcome in adult patients who are comatose and effects of sedation after cardiac arrest have cleared (weak recommendation, very low–certainty evidence). Serum biomarkers: We suggest using NSE within 72 h after ROSC, in combination with other tests, for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). There is no consensus on a threshold value. We suggest against using S-100B protein for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, low-certainty evidence). We suggest against using serum levels of glial fibrillary acidic protein, serum tau protein, or neurofilament light chain for predicting poor neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence) Neuroimaging: We suggest using GWR on brain computed tomography for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). However, no GWR threshold for 100% specificity can be recommended. We suggest using diffusion-weighted brain MRI for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence). We suggest using ADC on brain MRI for predicting neurological outcome of adults who are comatose after cardiac arrest (weak recommendation, very low–certainty evidence).

ADC indicates apparent diffusion coefficient; ALS, advanced life support; CoSTR, International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; CPR, cardiopulmonary resuscitation; ECPR, extracorporeal cardiopulmonary resuscitation; EEG, electroencephalogram; EvUp, evidence update; GWR, gray matter–to–white matter ratio; IHCA, in-hospital cardiac arrest; MRI, magnetic resonance imaging; NSE, neuron-specific enolase; OHCA, out-of-hospital cardiac arrest; PICO, population, intervention, comparator, outcome; PLR, pupillary light reflex; RCT, randomized controlled trial; ROSC, return of spontaneous circulation; SSEP, somatosensory evoked potential; and SysRev, systematic review.

CoSTR documents are available at https://costr.ilcor.org/.