2022 International Consensus on Cardiopulmonary

Resuscitation and Emergency Cardiovascular

Care Science With Treatment Recommendations Summary
From the Basic Life Support; Advanced
Life Support; Pediatric Life Support; Neonatal Life
Support; Education, Implementation, and Teams;
and First Aid Task Forces

Unggul Pribadi – GUP

SPV: dr Antonius Freddy SpEM KEC
 Table of contents
01 Introduction 05 Neonatal Life Support

02 Basic Life Support 06 First Aid

03 Advanced Life Support 07 Education, Implementation, and

Teams

04 Pediatric Life Support

 01
Introduction
You can enter a subtitle here if you need it
International Liaison Committee on
Resuscitation
The sixth in a series of annual International
Liaison Committee on Resuscitation (ILCOR)
International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care
Science With Treatment Recommendations (CoSTR)
publications summarizing the ILCOR task force analyses
of published resuscitation evidence. The 2022
review includes 21 topics addressed with systematic
reviews (SysRevs) by the 6 task forces.
 02
Basic Life Support
You can enter a subtitle here if you need it
02 Passive Ventilation Techniques
ILCOR suggest against the routine use of passive ventilation techniques(eg,
positioning the body, opening the airway, passive oxygen administration,
Boussignac tube, constant flow insufflation of oxygen) during conventional
CPR (weak recommendation,very low–certainty evidence).
02 Minimizing Pauses in Chest
Compressions
• Suggest CPR fraction and perishock pauses in clinical practice be monitored as part of a
comprehensive quality improvement program for cardiac arrest designed to ensure high-
quality CPR delivery and resuscitation care across resuscitation systems (weak
recommendation, very low–certainty evidence).
• Suggest preshock and postshock pauses in chest compressions be as short as possible
(weak recommendation, very low–certainty evidence).
• Suggest that the CPR fraction during cardiac arrest (CPR time devoted to compressions)
should be as high as possible and be at least 60% (weak recommendation, very low–
certainty evidence).
02 CPR During Transport
• Suggest providers deliver resuscitation at the scene rather than undertake ambulance
transport with ongoing resuscitation unless there is an appropriate indication to justify
transport (eg, extracorporeal membrane oxygenation; weak recommendation, very low–
certainty evidence)
• The quality of manual CPR may be reduced during transport. We recommend that
whenever transport is indicated, emergency medical services providers should focus on
the delivery of high-quality CPR throughout transport (strong recommendation, very
low–certainty evidence).
02 C-A-B or A-B-C in Drowning

• Recommend compression-first strategy (C-A-B) for laypeople providing

resuscitation for adults and children in cardiac arrest caused by drowning
(good practice statement)
• recommend that health care professionals and those with a duty to respond to
drowning (eg, lifeguards) consider providing rescue breaths/ventilation first
(A-BC) before chest compressions if they have been trained to do so (good
practice statement).
 03
Advanced Life Support
03 Temperature Management After Cardiac

• suggest actively preventing fever by targeting a temperature ≤37.5° C for

patients who remain comatose after ROSC from cardiac arrest (weak
recommendation, low-certainty evidence).
• recommend against the routine use of prehospital cooling with rapid infusion
of large volumes of cold intravenous fluid immediately after ROSC (strong
recommendation, moderate-certainty evidence).
• suggest surface or endovascular temperature control techniques when
temperature control is used in comatose patients after ROSC (weak
recommendation, low-certainty evidence).
03 POCUS as a Diagnostic Tool During
Cardiac Arrest
• suggest against routine use of POCUS during CPR to diagnose reversible
causes of cardiac arrest (weak recommendation, very low–certainty evidence)
• suggest that if POCUS can be performed by experienced personnel without
interrupting CPR, it may be considered as an additional diagnostic tool when
clinical suspicion for a specific reversible cause is present (weak
recommendation, very low–certainty evidence).
03 Use of Vasopressin and Corticosteroids
During Cardiac Arrest
• suggest against the use of the combination of vasopressin and corticosteroids
in addition to usual care for adult IHCA because of low confidence in effect
estimates for critical outcomes (weak recommendation, low to moderate-
certainty evidence)
• suggest against the use of the combination of vasopressin and corticosteroids
in addition to usual care for adult OHCA (weak recommendation, very low– to
low-certainty evidence)
03 Post–Cardiac Arrest Coronary
Angiography
• When CAG is considered for comatose postarrest patients without ST-segment
elevation, we suggest that either an early or a delayed approach for
angiography is reasonable (weak recommendation, low-certainty evidence)
• We suggest early CAG in comatose post–cardiac arrest patients with ST-
segment elevation (good practice statement)
 04
Pediatric Life Support
04 Public-Access Devices

• suggest the use of an AED by lay rescuers for all children >1 year of age who
have nontraumatic OHCA (weak recommendation, very low–certainty
evidence)
• cannot make a recommendation for or against the use of an AED by lay
rescuers for all children <1 year of age with nontraumatic OHCA
04 PEWSs With or Without Rapid Response
Teams
• suggest using PEWSs to monitor hospitalized children, with the aim of
identifying those who may be deteriorating (weak recommendation, low-
certainty evidence)
 05
NEONATAL LIFE
SUPPORT
05 Maintaining Normal Temperature
Immediately After Birth in Late Preterm and
Term Infants 1 of 2
• In late preterm and term newborn infants (≥34 weeks’ gestation), we suggest
the use of room temperatures of 23º C compared with 20º C at birth in order to
maintain normal temperature (weak recommendation, very low– certainty
evidence)
• In late preterm and term newborn infants (≥34 weeks’ gestation) at low risk of
needing resuscitation, we suggest the use of skin-to-skin care with a parent
immediately after birth rather than no skin-to-skin care to maintain normal
temperature (weak recommendation, very low–certainty evidence)
05 Maintaining Normal Temperature
Immediately After Birth in Late Preterm and
Term Infants 2 of 2
• In some situations in which skin-to-skin care is not possible, it is reasonable to consider
the use of a plastic bag or wrap, among other measures, to maintain normal temperature
(weak recommendation, very low– certainty evidence)
• In late preterm and term newborn infants (≥34 weeks’ gestation), for routine use of a
plastic bag or wrap in addition to skin-to-skin care immediately after birth compared
with skin-to-skin care alone, the balance of desirable and undesirable effects was
uncertain. Furthermore, the values, preferences, and cost implications of the routine use
of a plastic bag or wrap in addition to skin-to-skin care are not known; therefore, no
treatment recommendation can be formulated
05 Suctioning Clear Amniotic Fluid at Birth

• suggest that suctioning of clear amniotic fluid from the nose and mouth should
not be used as a routine step for newborn infants at birth (weak
recommendation, very low–certainty evidence)
05 Tactile Stimulation for Resuscitation
Immediately After Birth
• suggest that it is reasonable to apply tactile stimulation in addition to routine
handling with measures to maintain temperature in newborn infants with
absent, intermittent, or shallow respirations during resuscitation immediately
after birth (weak recommendation, very low–certainty evidence)
05 Delivery Room Heart Rate Monitoring to
Improve Outcomes for Newborn Infants

• suggest that the use of ECG, if resources permit, for heart rate assessment of a
newborn infant requiring resuscitation in the delivery room is reasonable
(weak recommendation, low-certainty evidence)
• When ECG is not available, auscultation with pulse oximetry is a reasonable
alternative for heart rate assessment, but the limitations of these
modalitiesshould be kept in mind (weak recommendation, lowcertainty
evidence)
05 CPAP Versus No CPAP for Term
Respiratory Distress in the Delivery Room

• For spontaneously breathing late preterm and term newborn infants in the
delivery room with respiratory distress, there is insufficient evidence to
suggest for or against routine use of CPAP compared with no CPAP
05 SGAs for Neonatal Resuscitation
• Suggest that an SGA may be used in place of a face mask for newborninfants
of ≥34 0/7 weeks’ gestation receiving intermittent PPV during resuscitation
immediately after birth where resources and training permit (weak
recommendation, low-certainty evidence).
05 Respiratory Function Monitoring During
Neonatal Resuscitation at Birth
• There is insufficient evidence to make a recommendation for or against the use
of an RFM in newborn infants receiving respiratory support at birth (low-
certainty evidence)
 06
FIRST AID TASK
FORCE
06 The Recovery Position for Maintenance of Adequate
Ventilation and the Prevention of Cardiac Arrest

• When providing first aid to a person with a decreased level of responsiveness

of nontraumatic origin who does not require immediate resuscitative
interventions, we suggest the use of the recovery position (weak
recommendation, very low–certainty evidence)
 07
EDUCATION,
IMPLEMENTATION,
AND TEAMS
07 Prearrest Prediction of Survival After
IHCA
• recommend against using any currently available prearrest prediction rule as a sole
reason not to resuscitate an adult with IHCA (strong recommendation, very low–
certainty evidence)
• unable to make a recommendation about using prearrest prediction rules to facilitate do
not attempt CPR (DNACPR) discussions with adult patients, pediatric patients, or their
substitute decision maker because there are no studies investigating the clinical
implementation of such a score for this indication
• We are unable to provide any recommendation for pediatric patients because no studies
on children were identified
07 BLS Training for Likely Rescuers of
High-Risk Populations
• recommend BLS training for likely rescuers of populations at high risk of
OHCA (strong recommendation, low- to moderate-certainty evidence)
07 Patient Outcome and Resuscitation Team
Members Attending ALS Courses
• recommend the provision of accredited ALS training (ACLS, ALS) for health
care providers who provide ALS care for adults (strong recommendation, very
low– certainty evidence)
• recommend the provision of accredited courses in NRT (NRT, NRP) and HBB
for health care providers who provide ALS care for newborns and babies
(strong recommendation, very low–certainty evidence)
07 Blended Learning for Life Support
Education
• recommend a blended-learning as opposed to nonblended approach for life
support training when resources and accessibility permit its implementation
(strong recommendation, very low–certainty evidence)
“A helping hand, caring eyes, and a
willing heart are the keys to saving lives”
— Anonymous
 Thanks!
unggulpribadi@student.ub.ac.id
Unggul.pribadi@gmail.com

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