Levels of Evidence in Resus Science

Question 1

ILCOR?

Answer 1

International Liaison Committee On Resuscitation.

Formed 1992. Individual member groups had to produce guidelines.

Meet twice a year.

(33 members of ERC)

Question 2

CoSTR

Answer 2

Consensus on Science and Treatment Recommendations

Question 3

GRADE

Answer 3

Grading, Recommendations, Assessment and Development and Evaluation

(2000)

Question 4

What are the main outcomes for the ILCOR?

Answer 4

Produce CoSTR ->

Individual councils produce guidelines based on the CoSTR

Question 5

New to 2015?

Answer 5

First Aid

Question 6

7 Task Forces?

Answer 6

ALS
BLS
ACS
PLS
NLS
Education and Implementation
First Aid - 2015

Question 7

How many PICO questions?

Answer 7

169

Question 8

Rough process for producing CoSTRs

Answer 8

Research questions produced (PICO) -> search Algorithm -> Selection criteria -> Evidence quality assessed (using GRADE) -> Formulate recommendations

Question 9

What happens after CoSTRs?

Answer 9

Local factors/contextualisation -> guidelines written/implemented.

Question 10

PICO?

Answer 10

Population, Intervention, Comparison, Outcome

Question 11

4 classifications of quality in GRADE?

Answer 11

High, moderate, low and very low.

Question 12

Type of evidence - how many points?

Answer 12

4 for RCT/systematic review

2 for observational - case study/cohort

Question 13

How does quality affect points?

Answer 13

Lose 1 point for every problem: blindings, follow up/withdrawls, sparse data, allocation concealment and method concerns.

(Comparison of below 200 is considered sparse)

Question 14

GRADE Points in terms of consistency ?

Answer 14

Evidence of effect in all studies +1
All similar results 0
Lack of agreement -1

Question 15

No RCT/SR in PICO?

Answer 15

No clinically important results.

Observational only - when RTCs are unethical

Question 16

GRADE Directness points?

Answer 16

0 for population broadly generalizable.
Lose a point for each problem, up to two
(examples: population too broad, population too restricted or co-interventions)

Question 17

Effect size - points in GRADE system?

Answer 17

Add 1 point for RR or OR of 2 ore more.

Add 2 points in RR or OR is 5 or more.

Question 18

Key point with GRADE?

Answer 18

Only relates to that particular PICO question, not a measure of the quality of that study in particular.

Question 19

Four factors that help experts to classify the strength of recommendation?

Answer 19

• Balance Between Desirable and Undesirable Effects
• Quality of Evidence
• Values and Preferences
• Costs

Question 20

What must happen once local resuscitation guidelines are written?

Answer 20

ERC and General Assembly must approve them.