1 / 21

Guidelines for Cardiac Care

From Evidence to EMS Practice: Building the National Model The Kellogg Conference Hotel, Washington, DC September 4-5, 2008. Guidelines for Cardiac Care. Robert E. O’Connor, M.D., MPH. ILCOR Science and Guidelne Update.

kiona-dotson
Télécharger la présentation

Guidelines for Cardiac Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. From Evidence to EMS Practice: Building the National Model The Kellogg Conference Hotel, Washington, DC September 4-5, 2008 Guidelines for Cardiac Care Robert E. O’Connor, M.D., MPH

  2. ILCOR Science and Guidelne Update Search, Review and Debate Scientific Evidence, Manage Conflict of Interest, Summarize consensus treatment recommendations, identify gaps in knowledge, explore controversies ILCOR Continuous International Science Review Councils Develop Guidelines and Revise Materials Councils Rollout Training

  3. INTERNATIONAL EVIDENCE-BASED CPR, ECC Implementation • Base guidelines based on the BEST science • Collaborate with worldwide experts • Evaluate evidence objectively • Avoid biases, disclose conflicts of interest

  4. Generalizable knowledge for better clinical practice and healthcare • knowledge from research (‘research evidence’) • knowledge from the analysis of routinely collected and audit data (‘statistics’) • knowledge from the experience of providers and patients (‘know how’)

  5. From Question to Guideline Task Force 1 • Identifies Questions • Assign Worksheet Authors Question International 2010 CPR Conference 2 4 Worksheet Authors • Review Extranet • Searches literature • Endnote, Pubmed, • Embase, Cochrane • Identifies and reads • pertinent articles • Completes worksheet • Worksheets presented • and discussed • Consensus reached ILCOR Consensus On Science Worksheet submission 3 Worksheet Review Guideline recommendation • Task Force Co-Chairs • “Worksheet Gurus” Worksheet Public Comment Worksheet Accepted

  6. Conflict of Interest • A specific conflict of interest form will need to be completed electronically, and updated on a regular basis, as part of the registration process. • In addition to this, to facilitate the review process, a brief declaration regarding any relevant conflicts is required for each worksheet on behalf of all authors.

  7. Asking the Question: the PICO format

  8. Databases to be searched • The Cochrane Library (for Systematic Reviews, DARE, and the Central register of Controlled Trials) • Medline (eg. via PubMed, OVID or Scopus) • Embase • the AHA Endnote database • Secondary Searches

  9. Levels of Evidence for Therapeutic Interventions 2010 • LOE 1: Randomised Controlled Trials (or meta-analyses of RCTs) • LOE 2: Studies using concurrent controls without true randomisation (eg. “pseudo”-randomised)(or meta-analyses of such studies) • LOE 3: Studies using retrospective controls • LOE 4: Studies without a control group (eg. case series) • LOE 5: Studies not directly related to the specific patient/population (eg. different patient/population, animal models, mechanical models etc.)

  10. Quality of Study 2008 • Good studies would be expected to have most/all of the quality items suggested to assess the type of study (see below). • Fair studies would be expected to have some of the quality items suggested to assess the type of study (see below). • Poor studies would be expected to have few of the quality items suggested to assess the type of study (see below), but to be of sufficient vale to include for further review.

  11. The choice of outcome designations include: A = Return of spontaneous circulation B = Survival of event C = Survival to hospital discharge D = Intact neurological survival E = Other endpoint

  12. Neutral/opposing evidence table denotes key article(s)

  13. Important Details from c2005 • Conflict of Interest “Ad Hoc Team” • Most controversial topics session • Lockbox Concept • Collaborating Agencies • Posting of Worksheets to Website: • Talley: >280 Topics and >400 Worksheet Authors • 40% of >300 International scientists were international • WWW.C2005.ORG

  14. 2010 Science Publications –December Animated ILCOR Timeline toward 2010(12March 2007) ILCOR Evidence Evaluation Posted December 2009 ERC/ ILCOR Ghent May 2008 ILCOR SIGNOFF New York May 2010 ILCOR/ ???? April or May 2009 ILCOR/ReSS Orlando Nov 2007 Jan 2011 Jan 2010 Jan 2008 Jan 2009 Lockbox Councils: Guidelines and Training Materials Rollouts 2011 ILCOR/ReSS ChicagoNov 2009 ILCOR/ReSS New Orleans Nov 2008 ILCOR March 2007 South Africa International Consensus Conference February, 2005 (Dallas)

  15. Topic Domains - columns of science EMT - P EMT - I Provider Level EMT - B First Responder Interfacility Transport

  16. Resuscitation Council of Asia

  17. Do the right things... and…Do the things right!

More Related