Developing Process and Progress in 2015 CPR Guidelines

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1 Planning of Korean CPR guideline development Sung Phil Chung, MD Gangnam Severance Hospital Yonsei University, Seoul, Korea

2 Contents Previous Korean CPR guidelines KACPR development process Adaptation ILCOR CoSTR & AHA/ERC guideline De novo development Methodology Organization Format Terminology Time table

Previous Korean CPR guidelines 2006.8 (1 st ), 2011.

3 Previous Korean CPR guidelines (1 st ), (2 nd ) 공용심폐소생술가이드라인의개발및배포 용역사업 ( 황성오 ) 복지부중앙응급의료센터 Textbook style On line upload (kacpr.org) ILCOR 지침과의차이 현장에서 5-10 분동안 CPR/AED 권장 병원전심정지환자는항상병원이송 연령에관계없이전화우선 (call first)

4 2006 algorithm

5 2011 algorithm

6 Korean illustrations

7 ILCOR

8 RCA JAPAN KOREA TAIWAN THAILAND SINGAPORE PHILIPPINE

9 ILCOR CoSTR 2010 Adult BLS Defibrillation CPR technique and devices Advanced life support Acute coronary syndrome Pediatric BLS/ALS Neonatal resuscitation Education, implementation, and teams (First aid)

10 ERC vs AHA guideline Summary 2. Adult BLS 3. Electrical therapy 4. Adult ALS 5. ACS 6. Pediatric life support 7. Neonatal 8. Special circumstances 9. Education 10. Ethics 1. Summary 2. Evidence evaluation/conflict 3. Ethics 4. CPR overview 5. Adult BLS 6. Electrical therapy 7. CPR technique and devices 8. Adult ACLS 9. Post CA care 10. ACS 11. Acute stroke 12. Special situations 13. PBLS 14. PALS 15. Neonatal resuscitation 16. Education 17. First aid

11 Korean guideline 주요내용 / 심폐소생술관련윤리 / 기본소생술 / 전문심장소생술 / 소아소생술 / 신생아소생술 / 심폐소생술교육지침 / 229 A1. 급성관상동맥증후군 / 249 A2. 뇌졸중의치료 / 257

12 ILCOR timeline ILCOR CoSTR published Int l Consensus Conference ILCOR meeting (Canada) ILCOR meeting (Melbourne) ILCOR meeting (Vienna) ILCOR meeting (Orlando)

13 ILCOR active PICO question Basic Life Support (24) Advanced Life Support (38) Pediatric Life Support (21) Neonatal Resuscitation (28) Education, Implementation, and Teams (17) Acute Coronary Syndrome (19) First Aid (22) ILCOR SEERS website

14 GRADE methodology

15 ILCOR evidence review example Among adults and children who are receiving chest compressions in any setting (P), does delivery of chest compressions on the lower half of the sternum (I), compared with any other location for chest compressions (C), change survival with favorable neurological/ functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, cardiac output, harm (eg. rib fracture), coronary perfusion pressure (O)?

16 PubMed search 143 hits ( hand [Mesh] OR Hand placement [TIAB] OR hand position [TIAB] OR hand positioning [TIAB] OR finger placement [TIAB] OR finger position [TIAB] OR finger positioning [TIAB] OR alternative position OR alternative compression ) AND ("Resuscitation"[Mesh] OR resuscitat*[tiab] OR "cardiopulmonary resuscitation"[mesh] OR heart massage [Mesh] OR "cardiopulmonary resuscitation"[tiab] OR CPR[TIAB] OR chest compression [TIAB] OR chest compressions [TIAB] OR heart massage [TIAB] OR cardiac massage [TIAB] OR cardiac compression [TIAB] OR cardiac compressions [TIAB] OR thoracic compression [TIAB] OR thoracic compressions [TIAB]) NOT (animal[mesh] NOT humans[mesh]) NOT ("News" [Publication Type] OR "letter"[publication Type] OR "comment"[publication Type] OR "editorial"[publication Type] or Case Reports[Publication Type])

17 Study inclusion process PubMed, Embase, Cochrane, Relevant? 16 relevant studies 11 CT studies (8 Korean studies) 2 simulation studies Patient important outcome? > Physiologic outcome 3 studies were finally analyzed Cha et al (BP, EtCO 2 ) Qvigstad et al (EtCO 2 ) Orlowski et al (BP)

18 Development methodology De novo development

19 Development methodology Adaptation

20 Categorical approach ILCOR reviewed question CoSTR 2015 AHA/ERC guideline Expert consensus Adaptation Korea specific additional question Own evidence review process De novo guideline development Less than 10 questions

21 Summary of adaptation process

22 Adaptation process Acceptability ( 수용성 ) 인구집단의특성에차이가있는가? 환자의관점및선호가유사한가? 문화및가치관에부합하는가? Applicability ( 적용성 ) 시술이나장비가이용가능한가? 법적, 정책적장벽은없는가?

23 Consensus process

24 Scope of resuscitation research Contents Prehospital, epidemiology, BLS, AED, ACLS, PALS, NRP, education, PCA care, ethics, airway, special situation, organ donation Exclusion: non-arrest critical care (ex: sepsis), ACS, stroke, first aid Format clinical study, guidelines, systematic review, simulation study, since 1990~2014, English/Korean language Exclusion: animal study, one case report, in vitro study, letter

25 ILCOR basic search: PubMed "Resuscitation"[Mesh] OR resuscitat*[tiab] OR "cardiopulmonary resuscitation"[mesh] OR heart massage [Mesh] OR "cardiopulmonary resuscitation"[tiab] OR CPR[TIAB] OR chest compression [TIAB] OR chest compressions [TIAB] OR heart massage [TIAB] OR cardiac massage [TIAB] OR cardiac compression [TIAB] OR cardiac compressions [TIAB] OR thoracic compression [TIAB] OR thoracic compressions [TIAB]) NOT (animal[mesh] NOT humans[mesh]) NOT ("News" [Publication Type] OR "letter"[publication Type] OR "comment"[publication Type] OR "editorial"[publication Type] OR Case Reports[Publication Type]) AND ("1990/01/01"[PDAT] : "3000/12/31"[PDAT]

26 Adjustment process Relevance rate: 28.3% 66.2%

27 EMBASE

28 Web of science

29 Cochrane library

30 KoreaMed

31 CPR study including Korean author PubMed, Embase Web of science N=60 (>3) KoreaMed Duplication Not relevant N=284 N=125 (>2) N=451 N=247 편원저 237 종설 10 초록제외 N=192 편 원저 179 증례 8 종설 4 논평 1 N=189 명 (367 건 ) 교신저자 N=97 명 (181 건 ) 1 저자 N=127 명 (186 건 ) N=334 명 (498 건 ) 교신저자 N=150 명 (245 건 ) 1 저자 N=230 명 (252 건 )

32 Korean studies in resusci. area

33 Organization Steering committee Publication committee Advisory committee Term TF Design TF BLS ACLS Ped Education De novo Prehospital PCA NR

34 Multidisciplinary team 대한신경과학회 한국응급구조학회 대한응급의학회 대한마취과학회 대한적십자사 대한심장학회 대한소아과학회 대한신생아학회 대한간호협회

35 Sample format

36 CPG or textbook style CoSTR ERC guideline

37 Ex: Korean stroke guideline 1

38 Ex: Korean stroke guideline 2

39 Review article style

40 Term DB: 1 st edition 2008 년 2,800여단어 2005년 CPR 지침을반영 응급의료용어집 의학용어집 4판반영 의학용어집제5판 CPR guideline 개정 2015 지침반영?

41 Revision process 1 연구진구성 (2014.4) 일반용어집 : 정성필, 강형구, 최영환 Update: 김진우, 송소현, 박현경, 이미진, 장혜영 자문 : 도병수, 이중의, 박규남 용어집표제어추가, 수정 2010 CPR 지침반영, 새용어추가 의학용어집반영 (4판 5판 ) 일반용어, 약품명삭제 2,800 3,100 여단어

42 Revision process 2 한영편, 인명편삭제 약어편 영한편에포함 추가및수정사례 Amplitude-integrated EEG 진폭통합뇌파검사 Basic life support (K)(E) 기본소생술 기본생명유지술 Defibrillation (K) 세동제거, 잔떨림제거 (E) 제세동 심장충격 (K) 세동제거, 잔떨림제거 (E) 제세동 Biphasic (K) 이상성 ( 二相性 ) (E) 이중-, 이상성-, 양상형-, 양방향 양방향

44 Time table: preparation Organization 위원회, 분야별개발팀구성 관련학회, 단체의추천 Consensus meeting Methodology & process 교육 De novo development 상반기 ILCOR PICO review, 추가질문개발, 리뷰 ILCOR CoSTR open

45 Time table: development Adaptation ~12 AHA/ERC guideline appraisal AGREE II 에의한평가 분야별 adaptation External review Publication ~ 용어통일화, algorithm design Journal submission, web upload

46 Time table: implementation Distribution KACPR guideline conference 발표자료공개 ( 언론보도자료 ) Education materials Summary, Education slide illustration, poster 배포 Provider course update BLS, ACLS, KALS 상반기 하반기

47 많은관심과참여바랍니다 감사합니다

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<C0CEC5CFBCF6B7C3B1B3C0B0C1F6C4A7BCAD2D28C3D6C1BEC3E2B7C2C8AEC0CE292D312DC3D62E687770> 인턴 수련교육 및 진료 지침서 53 15. 심폐소생술 심폐소생술(Cardiopulmonary Resuscitation, CPR)이란 심장이 멎은 사람에게 인 공호흡과 인공순환을 유지하여 주요 장기에 산소를 공급하는 치료 술기이다. 심폐소생술에 관한 표준 가이드라인의 국제화를 위하여 1993년에 미국심장학 회(American Heart Association,