Table 16.
EIT Topics Reviewed by EvUps
| Topic/PICO | Year(s) last updated | Existing treatment recommendation | RCTs since last review, n | Observational studies since last review, n | Sufficient data to warrant SysRev? |
|---|---|---|---|---|---|
| EMS practitioner’s experience or exposure (EIT 437) | 2020 CoSTR | We suggest that EMS systems (1) monitor their clinical personnel’s exposure to resuscitation and (2) implement strategies when possible to address low exposure or ensure that treating teams have members with recent exposure (weak recommendation, very low–certainty evidence). | None | None | No |
| High-fidelity training (EIT 623) | 2015 CoSTR; 2020 EvUp | We suggest the use of high-fidelity manikins when training centers/organizations have the infrastructure, trained personnel, and resources to maintain the program (weak recommendations, very low–quality evidence). If high-fidelity manikins are not available, we suggest that the use of low-fidelity manikins is acceptable for standard ALS training in an educational setting (weak recommendations, low–quality evidence). | 1 SysRev and 3 RCTs | 1 | No |
| CACs (EIT 624) | 2019 CoSTR | We suggest that adult patients with nontraumatic OHCA be cared for in CACs rather than in non-CACs (weak recommendation, very low–certainty evidence). We cannot make a recommendation for or against regional triage by primary EMS transport of patients with OHCA to a CAC by primary EMS transport (bypass protocols) or secondary interfacility transfer to a CAC. The current evidence is inconclusive, and confidence in the effect estimates is currently too low to support an EIT and ALS Task Force recommendation. For patients with in-hospital cardiac arrest, we found no evidence to support an EIT and ALS Task Force recommendation. For the subgroup of patients with either shockable or nonshockable initial cardiac rhythm, the current evidence is inconclusive, and the confidence in the effect estimates is currently too low to support an EIT and ALS Task Force recommendation. |
1 SysRev and no RCTs |
11 | Yes |
| Timing for retraining (EIT 628) | 2015 CoSTR; 2020 EvUp | There is insufficient evidence to recommend the optimum interval or method for BLS retraining for laypeople. Because there is evidence of skills decay within 3 to 12 mo after BLS training and evidence that frequent training improves CPR skills, responder confidence, and willingness to perform CPR, we suggest that individuals likely to encounter cardiac arrest consider more frequent retraining (weak recommendation, very low–quality evidence). | 3 | 1 | No |
| Cognitive aids during resuscitation (EIT 629) | 2020 CoSTR | We recommend against the use of cognitive aids for the purposes of lay providers initiating CPR (weak recommendation, low-certainty evidence). We suggest the use of cognitive aids for health care providers during trauma resuscitation (weak recommendation, very low–certainty evidence). In the absence of studies on CPR, no evidence-based recommendation can be made. There are insufficient data to suggest for or against the use of cognitive aids in lay provider training. We suggest the use of cognitive aids for training of health care providers in resuscitation (weak recommendation, very low–certainty evidence). |
8 | 2 | Yes |
| TOR for in-hospital cardiac arrest (EIT 4002) | 2020 CoSTR | We did not identify any clinical decision rule that was able to reliably predict death after in-hospital cardiac arrest. We recommend against using the UN10 rule as a sole strategy to terminate in-hospital resuscitation (strong recommendation, very low–certainty evidence). | None | None | No |
| Precourse preparation for advanced courses (EIT 637) | 2020 CoSTR | We recommend distributing precourse learning formats preceding face-to-face training for participants of ALS courses (weak recommendation, very low– to low-certainty evidence). In addition, we strongly recommend providing the option of eLearning as part of a blended-learning approach to reduce face-to-face training time in ALS courses (strong recommendation, very low– to low-certainty evidence). | 1 | 1 | No |
| System performance improvements (EIT 640) | 2020 CoSTR | We recommend that organizations or communities that treat cardiac arrest evaluate their performance and target key areas, with the goal of improving performance (strong recommendation, very low–certainty evidence). | 1 SysRev | 7 | No |
| Community initiatives to promote BLS implementation (EIT 641) | 2015 CoSTR; 2020 ScopRev | The treatment recommendation (below) remains unchanged from 2015. We recommend implementation of resuscitation guidelines within organizations that provide care for patients in cardiac arrest in any setting (strong recommendation, very low quality of evidence). | 1 SysRev | 2 | No |
| Prehospital TOR rules (EIT 642) | 2020 CoSTR | We conditionally recommend the use of TOR rules to assist clinicians in deciding whether to discontinue resuscitation efforts out of hospital or transport to hospital with ongoing CPR (conditional recommendation, very low–certainty evidence). | None | 4 | No |
| CPR feedback devices during training (EIT 648) | 2020 CoSTR | We suggest the use of feedback devices that provide directive feedback on compression rate, depth, release, and hand position during CPR training (weak recommendation, low-certainty evidence). If feedback devices are not available, we suggest the use of tonal guidance (eg, music or metronome) during training to improve compression rate only (weak recommendation, low-certainty evidence). | 5 | None | No |
| BLS training in high-risk populations (EIT 649) | 2015 CoSTR | We recommend the use of BLS training interventions that focus on high-risk populations on the basis of the willingness to be trained and the fact that there is low harm and high potential benefit (strong recommendation, low–quality evidence). | 1 SysRev and no RCTs |
11 | Yes |
| Technology to engage first responders (EIT 878) | 2020 CoSTR | We recommend that citizens/individuals who are in close proximity to a suspected OHCA event and are willing to be engaged/notified by a smartphone app with a mobile positioning system or text message–alert system should be notified (strong recommendation, very low–certainty evidence). | None | 2 | No |
| Resuscitation team with ALS course training (EIT 4000) | 2020 CoSTR | We recommend the provision of accredited adult ALS training for health care providers (weak recommendation, very low–certainty evidence). | None | None | No |
| Opioid overdose first aid education (EIT 4001) | 2015 CoSTR; 2020 ScopRev | We suggest offering opioid overdose response education, with or without naloxone distribution, to persons at risk for opioid overdose in any setting (weak recommendation, very low quality of evidence). In making these recommendations, we place greater value on the potential for lives saved by recommending overdose response education, with or without naloxone, and lesser value on the costs associated with naloxone administration, distribution, or education. |
2 SysRevs and 2 RCTs | 6 | No |
| Facilitators and barriers to bystander CPR (EIT 4003) | 2020 EvUp | NA; an evidence update was performed for 2020 | None | 5 | No |
| Virtual reality, augmented reality, and gamified learning (EIT 4005) | 2020 EvUp | NA; an evidence update was performed for 2020 | 1 | 2 | No |
| In situ training (EIT 4007) | 2021 EvUp | NA; an evidence update was performed for the first time in 2021 | None | 4 | No |
ALS indicates advanced life support; app, application; BLS, basic life support; CAC, cardiac arrest center; CPR, cardiopulmonary resuscitation; EIT, Education, Implementation, and Teams; EMS, emergency medical services; EvUps, evidence updates; NA, not applicable; OHCA, out-of-hospital cardiac arrest; PICO, population, intervention, comparator, outcome; RCT, randomized controlled trial; ScopRev, scoping review; SysRev, systematic review; and TOR, termination of resuscitation.
CoSTR documents are available at https://costr.ilcor.org/.