Out-of-hospital cardiac arrest (OHCA) is a time-sensitive emergency associated with high mortality and substantial risk of neurological disability. Extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO) has been introduced for refractory cardiac arrest, but recent randomized controlled trials have reported conflicting results, and the benefit of ECPR implemented according to rigorously timed protocols remains uncertain. This trial evaluates whether emergency total extracorporeal life support (ECLS), with emphasis on expedited cannulation and active left ventricular (LV) unloading, improves 30-day survival with favourable neurological outcome compared with standard advanced cardiac life support (ACLS) with rescue ECLS in adults with refractory shockable out-of-hospital cardiac arrest. This is a prospective, investigator-initiated, multicenter, open-label randomized clinical trial conducted in eight experienced extracorporeal membrane oxygenation (ECMO) centers in the Taipei metropolitan area. Eligible adults aged 18–75 years with witnessed refractory shockable OHCA (ventricular fibrillation or pulseless ventricular tachycardia) who received bystander cardiopulmonary resuscitation (CPR) are randomized 1:1 on emergency department (ED) arrival. Participants are assigned to: (1) emergency total ECLS, with initiation as soon as possible after randomization and within 60 min of the emergency call, or (2) standard ACLS with rescue ECLS, in which at least 15 min of standard ACLS is provided in the ED before ECLS is considered. Both groups receive immediate coronary angiography and percutaneous coronary intervention (PCI) when indicated, and active LV unloading is recommended according to prespecified criteria. Survival at 30 days with favorable neurological status, defined as a Cerebral Performance Category score of 1 or 2. The ECLS-OHCA trial will provide complementary randomized evidence on the impact of expedited time-to-flow and protocolized LV unloading on neurological outcomes in refractory shockable OHCA and will explore the cost-effectiveness of this strategy. ClinicalTrials.gov: NCT06692075.

Hospital-at-home (HaH) programs provide acute medical care in home settings as an alternative to traditional inpatient hospitalization. In July 2024, the National Health Insurance Administration of Taiwan launched an HaH pilot program. This program focuses on older adults with frailty and operates through 2 referral models: emergency passed admission (EPA) and direct home admission (DHA). This retrospective observational study was conducted in the Xinwu-Tai region of New Taipei City, Taiwan, from September 2024 to June 2025. Patient screening records were reviewed to determine the reasons for enrollment failure and identify the outcomes of those admitted. Key variables included diagnosis, referral model, functional status, clinical stability, treatment duration, and readmission. Of 1462 emergency department (ED) person-days screened, only 180 (12.3

Background Out-of-hospital cardiac arrest (OHCA) is a highly time-sensitive medical emergency. Extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation, also known as extracorporeal cardiopulmonary resuscitation (ECPR), has been increasingly used in patients with refractory cardiac arrest. Despite promising results from observational studies, recent randomized controlled trials have reported conflicting evidence on the benefits of ECPR for refractory OHCA. This trial is designed to investigate the efficacy of expedited ECPR for refractory shockable OHCA using a strict ECPR application protocol and active left ventricular (LV) unloading strategies. Methods This is a multicenter randomized clinical trial (ClinicalTrials.gov NCT06692075). Eligible patients will be randomized in 1:1 ratio on arrival at emergency department into the emergency total extracorporeal life support ( total ECLS ) group and the standard advanced cardiac life support with the ECMO bailout ( standard ACLS ) group. For the emergency total ECLS group, patients will receive early initiation of ECMO within 15 minutes after randomization or up to 60 minutes after emergency calls. For standard ACLS with the ECMO bailout group, patients will receive standard ACLS for at least 15 minutes before initiating bailout ECMO. Survived patients without contraindications for coronary angiography will be transferred to the catheterization laboratory. Institutional protocols of post-cardiac arrest care will adhere to established recommendations from the latest guidelines. Active LV unloading is suggested if indicated. The primary endpoint is survival with a favorable neurological outcome at 30 days. Conclusion The ECLS-OHCA trial aims to provide complementary evidence supporting the use of ECPR in patients with refractory shockable OHCA and to assess the cost-effectiveness of its early implementation. ClinicalTrials.gov: NCT06692075.

Triple negative breast cancer (TNBC) is characterized by high heterogenicity and aggressiveness and autophagy plays a complicated role in cancer development. Zingerone is reported to possess multiple pharmacological activities, including antitumors. This study explored the biological role and the relevant mechanisms of zingerone in TNBC. Following zingerone treatment, the viability of normal breast cancer cells MCF-10A and TNBC cells (MDA-MB-231 and MDA-MB-468) was detected with CCK-8 assay. The proliferation, migration and invasion of TNBC cells were detected with colony formation, wound healing, and transwell assays. Western blot was used to detect the expressions of migration-, apoptosis- and autophagy-related proteins. Flow cytometry was used to detect the cell apoptotic level and immunofluorescence assay measured the autophagy. The experimental data revealed that zingerone with varying concentrations suppressed cell viability, proliferation, migration and invasion while promoting the apoptosis in TNBC, which might be mediated by autophagy activation. Besides, zingerone decreased HDAC1 expression in TNBC cells and regulated autophagy via HDAC1. Collectively, zingerone impeded the malignant progression of TNBC via inducing HDAC1-mediated autophagy.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Objective: A strengthened chain of survival benefits patient outcomes after out-of-hospital cardiac arrest (OHCA).2 Over the past decade, the Taipei Fire Department (TFD) has continuously implemented system-wide initiatives on this issue. We hypothesised that for adult, non-trauma OHCA patients, the bundle of these system-wide initiatives are associated with better outcomes. Methods: We conducted a registry-based, retrospective study to examine the association between consecutive system-level initiatives and OHCA survival on a two-yearly basis using trend analysis and multivariable logistic regression. The primary outcome was survival to hospital discharge (STHD) and favourable neurological status. Results: We analysed 18,076 cases from 2008 to 2017. The numbers of two-yearly cases of OHCA with resuscitation attempts from 2008 to 2017 were 3,576, 3,456, 3,822, 3,811, and 3,411. There was a significant trend of improved STHD (Two-fold) and favourable neurological outcome (Sixfold) over the past decade. Similar trends were observed in the shockable and non-shockable groups. Considering the first 2 years as baseline, the odds of STHD and favourable neurological status in the end of the initiatives increased significantly after adjusting for universally recognised predictors for OHCA survival. Conclusion: For non-trauma adult OHCA in Taipei, continuous, multifaceted system-wide initiatives on the community chain of survival were associated with improved odds of STHD and favourable neurologic outcomes.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Palmitic acid (PA) is a saturated free fatty acid which, when being excessive, accounts for lipotoxicity. Using human lung A549 cells as a model for lung alveolar type 2 epithelial cells, we found that challenge of A549 cells with PA resulted in apoptotic cell death, as reflected by positive annexin V and PI staining, and also appearance of cleaved caspase-3. PA treatment also caused depletion of intracellular Ca2+ store, endoplasmic reticulum (ER) stress, and oxidative stress. Tannic acid (TA), a polyphenol present in wines and many beverages, alleviated PA-induced ER stress, oxidative stress and apoptotic death. Thus, our results suggest PA lipotoxicity in lung alveolar type 2 epithelial cells could be protected by TA.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

Aim To perform a systematic review of the literature on intravenous (IV) vs. intraosseous (IO) administration of drugs during cardiac arrest in order to inform an update of international guidelines. Methods The review was performed according to PRISMA guidelines and registered on PROSPERO. Medline, Embase and Evidence-Based Medicine Reviews were searched on December 17, 2019 for studies comparing IV to IO administration of drugs. The population included neonatal, paediatric, and adult patients with cardiac arrest. Two investigators reviewed each search for study relevance, extracted data, and assessed the risk of bias of individual studies. Meta-analyses were performed for studies without a critical risk of bias. Certainty of evidence was evaluated using GRADE. Results We included six observational studies comparing IV to IO administration of drugs and two randomized trials assessing the effect of specific drugs in subgroups related to IV vs. IO administration. All studies included adult out-of-hospital cardiac arrest patients. No studies were identified in neonatal or paediatric patients. The risk of bias for the observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. The meta-analyses excluding studies with a critical risk of bias favoured IV access for all outcomes. Using GRADE, the certainty of evidence was judged at very low. Subgroup analyses of the two randomized trials demonstrated no statistically significant interactions between the route of access and study drugs on outcomes. However, these trials were underpowered to assess such interactions. Conclusions We identified a limited number of studies comparing IV vs. IO administration of drugs during cardiac arrest. Pooled results from four observational studies favoured IV access with very low certainty of evidence. From the subgroup analyses of two randomized clinical trials, there was no statistically significant interaction between the route of access and study drug on outcomes.

HomeCirculationVol. 142, No. 16_suppl_1Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessReview ArticlePDF/EPUBEvidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Peter T. Morley, MBBS, Dianne L. Atkins, MD, Judith C. Finn, RN, PhD, Ian Maconochie, PhD, Jerry P. Nolan, MBChB, Yacov Rabi, MD, Eunice M. Singletary, MD, Tzong-Luen Wang, MD, PhD, Michelle Welsford, MD, Theresa M. Olasveengen, MD, PhD, Richard Aickin, MBChB, John E. Billi, MD, Robert Greif, MD, MME, Eddy Lang, MD, Mary E. Mancini, RN, PhD, William H. Montgomery, MD, Robert W. Neumar, MD, PhD, Gavin D. Perkins, MD, Jasmeet Soar, MA, MBBChir, Myra H. Wyckoff, MD and Laurie J. Morrison, MD, MSc Peter T. MorleyPeter T. Morley Search for more papers by this author , Dianne L. AtkinsDianne L. Atkins Search for more papers by this author , Judith C. FinnJudith C. Finn Search for more papers by this author , Ian MaconochieIan Maconochie Search for more papers by this author , Jerry P. NolanJerry P. Nolan Search for more papers by this author , Yacov RabiYacov Rabi Search for more papers by this author , Eunice M. SingletaryEunice M. Singletary Search for more papers by this author , Tzong-Luen WangTzong-Luen Wang Search for more papers by this author , Michelle WelsfordMichelle Welsford Search for more papers by this author , Theresa M. OlasveengenTheresa M. Olasveengen Search for more papers by this author , Richard AickinRichard Aickin Search for more papers by this author , John E. BilliJohn E. Billi Search for more papers by this author , Robert GreifRobert Greif Search for more papers by this author , Eddy LangEddy Lang Search for more papers by this author , Mary E. ManciniMary E. Mancini Search for more papers by this author , William H. MontgomeryWilliam H. Montgomery Search for more papers by this author , Robert W. NeumarRobert W. Neumar Search for more papers by this author , Gavin D. PerkinsGavin D. Perkins Search for more papers by this author , Jasmeet SoarJasmeet Soar Search for more papers by this author , Myra H. WyckoffMyra H. Wyckoff Search for more papers by this author and Laurie J. MorrisonLaurie J. Morrison Search for more papers by this author Originally published21 Oct 2020https://doi.org/10.1161/CIR.0000000000000891Circulation. 2020;142:S28–S40ContentsEvidence Evaluation Process S292015 Evidence Evaluation Process S292016 to 2020 Evolution of the Evidence Evaluation Process S29Types of Evidence Evaluation S30Management of Potential Conflicts of Interest Throughout the Process S35Next Steps S36Disclosures S36References S38“Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”— H. James HarringtonThe 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) is the result of a long period of collaboration of international experts under the umbrella of the International Liaison Committee on Resuscitation (ILCOR). The ILCOR organization comprises the world’s leading resuscitation councils: the American Heart Association (AHA), the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian and New Zealand Committee on Resuscitation, the Resuscitation Council of Southern Africa, the InterAmerican Heart Foundation, and the Resuscitation Council of Asia. The vision of ILCOR is “saving more lives globally through resuscitation,” and its mission is “to promote, disseminate, and advocate international implementation of evidence-informed resuscitation and first aid, using transparent evaluation and consensus summary of scientific data.” These goals are outlined in more detail in the 2016 to 2020 ILCOR Strategic Plan (as electronic supplement).1There are 6 ILCOR task forces: Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid.2 Task force members represent diverse countries and bring expertise in all aspects of prearrest, arrest, postarrest care, and first aid. ILCOR appoints task force members by using a request for application and a rigorous selection process, with the goal of balancing scientific and clinical expertise, representation across ILCOR member councils, representation across gender, and diversity across career levels (early, mid, senior). Each task force also has an elected chair and deputy chair, and all positions have a required (time-based) turnover of positions. The Acute Coronary Syndromes Task Force was not continued after 2015, but relevant questions continue to be addressed within existing task forces.ILCOR maintains its commitment to a rigorous and continuous review of scientific literature focused on resuscitation, cardiac arrest, relevant conditions requiring first aid, related education, implementation strategies, and systems of care.ILCOR is also committed to publishing regular and ongoing CoSTRs. The science evaluation performed by ILCOR underpins the development of international resuscitation council guidelines (including the AHA and the European Resuscitation Council).Evidence Evaluation ProcessThe most important product of the ILCOR evidence evaluation process is the summary of the evidence identified (consensus on science) and the accompanying treatment recommendations. ILCOR is committed to transparency in presenting consensus descriptions and summaries of the evidence, and the creation of treatment recommendations whenever consensus can be achieved. The processes to evaluate the information available has evolved substantially over the past 2 decades, as has ILCOR’s approach to reviewing the science related to its mission.2015 Evidence Evaluation ProcessIn 2015, ILCOR published its detailed 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.3,4 It was a very detailed process in which 250 evidence reviewers from 39 countries completed 165 systematic reviews (SysRevs) on resuscitation-related questions. These reviews were completed according to a detailed process, including the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).5,6 These reviews were published in summary format as the 2015 CoSTR.3,4 The supporting documentation for these SysRevs was published in electronic format with the key components of the review (including PICO [population, intervention, comparator, outcome] question, search strategies, bias assessment tools, GRADE evidence profile tables, and CoSTRs) housed in a repository. This process was also underpinned by a rigorous conflict of interest (COI) process, and each SysRev was peer reviewed.5,6The detailed methodology for the SysRevs completed for the 2015 CoSTR is outlined in the evidence evaluation chapter.5,6 Very few of these SysRevs went on to publication.2016 to 2020 Evolution of the Evidence Evaluation ProcessBeginning in 2016, ILCOR reviewed and restructured the evidence evaluation process to better meet its commitment to facilitate a rigorous, continuous evidence review. ILCOR committed to change the CoSTR evidence review and publication from every 5 years to an annual update. The organization then began creating the infrastructure to support these reviews and facilitate ILCOR’s vision and mission.1Continuous Evidence Evaluation Working GroupILCOR created a governance process to support ongoing evidence evaluation. The Continuous Evidence Evaluation Working Group (CEE WG) was created, and it commissioned high-quality SysRevs to be performed by knowledge synthesis units (KSUs) and expert systematic reviewers (ESRs). More details of the role and components of these KSUs and ESRs are described in the subsequent sections. The publication of peer-reviewed SysRevs in addition to the peer-reviewed ILCOR CoSTRs maximizes dissemination of the evidence. The first of these commissioned SysRevs was published in 2017,7 and, on the basis of this review, the basic life support and pediatric life support CoSTR Updates were published in 2017.8,9 Additional SysRevs provided the foundation for CoSTR Updates in 201810,11 and 2019.12,13 In all, 4 KSU pilots and 24 expert SysRev pilots were commissioned. The CoSTRs and evidence-to-decision frameworks and links to the International Prospective Register of Systematic Reviews (PROSPERO) registration and published SysRev manuscripts are posted on ILCOR.org.14The CEE WG provided additional expertise and resources to support the task forces. Domain leads are researchers and clinicians with specialized knowledge in topics such as defibrillation or cardiopulmonary resuscitation adjuncts. They were appointed to assist the task forces in identifying and analyzing relevant evidence. CEE WG members, domain leads, task force chairs and other experts subscribed to publication alerts to keep them aware of studies published relevant to their review topics and areas of expertise.ILCOR also facilitated the creation of a more permanent document and template repository on its website.14 This repository houses the instructional and process documents that support the continuous evidence evaluation process,15 an explanatory video about the continuous evidence evaluation process,16 the draft CoSTRs,17 and final versions of the CoSTRs. This site has a public interface where draft material is posted for public review and comments during the creation of the SysRevs and CoSTRs.The ILCOR SysRev process continues to be based on the methodological principles published by the National Academy of Health and Medicine (formerly the Institute of Medicine) in 2011,18 the Cochrane Library,19–21 GRADE,22 and the reporting guidelines based on the recommendations from Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA23).24 The details of this evidence evaluation process established by the CEE WG for the KSUs and ESRs can be found in the workflow document25 and are outlined in a descriptive video.16Scientific Advisory CommitteeThe CEE WG was created as the interim methodological governance process in 2016, and it continued to function until the ILCOR Scientific Advisory Committee (SAC) was convened. The SAC first met in August 2019, with elected members and some ex-officio representation. Committee appointments required methodological expertise, a track record of involvement with review of resuscitation science, and appropriate content knowledge. Members met regularly (every 1–2 weeks) by webinar and continued the governance of the CEE process. The new and updated process documents and reporting templates were posted on the ILCOR website.15 Specific SAC members were assigned to work with specific ILCOR task forces, to provide a conduit for methodological expertise and advice, and to facilitate completion of and the methodological rigor of the task force–based evidence reviews.Prioritization of Questions AskedThe ILCOR task forces prioritized topics for review in several ways. Topics related to the large existing list of ILCOR PICO questions from 2010 and 2015 were initially prioritized by the relevant ILCOR task forces. The task forces continually reevaluated their priorities using several tools, including areas identified as gaps by the 2015 reviews,26,27 ongoing literature searches performed by the domain leads, information gleaned from recently completed studies, “hot” topics, and areas of controversy or confusion raised by task force members or ILCOR member councils. All prioritized questions were revised and written into a PICOST (population, intervention, comparator, outcome, study design, time frame) format to facilitate the planned review. Diagnostic and prognostic questions required a modification of the standard PICOST format. All PICOSTs for ILCOR reviews were required to be reviewed and approved by members of the CEE WG/SAC.Public CommentILCOR is committed to obtaining input from the broadest community possible to help it establish the most relevant topics, the best way to describe its processes for maximum transparency, and the most useful treatment recommendations. Beginning in 2016, ILCOR has communicated with lay and professional organizations to direct the public to the ILCOR website and sends email communications to those previously engaged to notify them of any additional postings for comment. The individual draft 2020 CoSTRs were accessed and viewed more than 200 000 times.Each submitted CoSTR is accompanied by a completed GRADE evidence-to-decision framework,28,29 which is used by the task force to guide its members through a list of key questions. The ILCOR task forces are given guidance on how to provide background information outlining their discussions in sections of the reviews titled “Justification and Evidence-to-Decision Framework Highlights” and “Task Force Insights.” The task forces are also requested to provide a list of key gaps in knowledge that had been identified. The product of these deliberations is published as a draft CoSTR online,17 in the yearly CoSTR summary documents,8–13 and in the more complete summary documents (such as this publication series).30 The integrity of these products and a transparent description of the processes that underly them is crucial because these products are used by the international guideline-writing bodies to write the resuscitation guidelines.Types of Evidence EvaluationThe 2020 CoSTR includes many SysRevs (performed by the relevant task forces, with or without additional appointed experts), but for the first time it also includes other evidence evaluation processes: task force–based scoping reviews (ScopRevs) and international collaborator-based evidence updates (EvUps). Table 1 lists some of the key components of each of these reviews.Table 1. Overview of the Evidence Evaluation Processes for the 2020 CoSTRKSU SysRevESR SysRevTask Force SysRevTask Force ScopRevEvUpQuestion based on task force priorities✓✓✓✓±Guidance for reviewPRISMAPRISMAPRISMAPRISMA-ScRILCOR and member councilsSearch strategy created by information specialist*✓✓✓✓±Lead for reviewKSUESRILCOR Task ForceILCOR Task ForceILCOR member council collaboratorsContent experts from task force✓✓✓✓±Review of published data✓✓✓✓✓Combination of data (eg meta-analysis)✓✓✓--Bias assessment✓✓✓--GRADE evidence profile tables✓✓✓--GRADE EtD✓✓✓--Task force review and insights incorporated✓✓✓✓-Consensus on science✓✓✓--Revision/creation of treatment recommendation†✓✓✓--Opportunity for public comment✓✓✓✓-Peer-reviewed publication†✓✓±±-Included in 2020 CoSTR manuscriptSummary, including PICOST, CoSTRSummary, including PICOST, CoSTRSummary, including PICOST, CoSTRSummary, including PICOSTSummary, including PICOSTIncluded in 2020 CoSTR appendixes in the Data SupplementEtD:EtD:EtD:Supplement Appendix BSupplement Appendix CSupplement Appendix ASupplement Appendix ASupplement Appendix A* Peer-reviewed search strategies were created by information specialists for all ESR and KSU SysRevs.† Independent peer review was required for all KSU and ESR SysRevs before posting of CoSTRs and journal submission of SysRevs.✓ indicates required; ±, not required but preferred; -, not consistent with methodology; CoSTR, Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; ESR, expert systematic reviewer; EtD, evidence-to-decision framework; EvUp, evidence update; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; ILCOR, International Liaison Committee on Resuscitation; KSU, knowledge synthesis unit; PICOST, population, intervention, comparator, outcome, study design, time frame; PRISMA, Preferred Reporting Items for a Systematic Review and Meta-Analysis23; PRISMA-ScR, Preferred Reporting Items for a Systematic Review and Meta-Analysis–extension for Scoping Reviews32; ScopRev, scoping review; and SysRev, systematic review.Systematic ReviewsIdeally, every ILCOR topic reviewed would have the benefit of a meticulously performed SysRev as the basis for critical appraisal. The Academy of Medicine defines a SysRev as a “scientific investigation that focuses on a specific question and uses explicit, prespecified scientific methods to identify, select, assess, and summarize the findings of similar but separate studies. It may include a quantitative synthesis (meta-analysis), depending on the availability of data.”18 Although the ILCOR membership values SysRevs, many resuscitation topics and questions are still not addressed by adequately powered, randomized clinical trials or high-quality observational studies to evaluate outcomes that the task forces agree are critical.31,32The list of processes common to all ILCOR SysRevs is outlined in Table 2. Some of these steps are outlined in more detail in the sections that follow. The information from these SysRevs has been incorporated into the respective task force chapters. The CoSTR and evidence-to-decision frameworks for these reviews were posted in draft form on the ILCOR website,17 and the approved CoSTRs are included in the respective task force publication, with an evidence-to-decision table for each new CoSTR in Supplement Appendix A in the Data Supplement.Pathways to Completion of SysRevsIn the evidence evaluation process that resulted in the 2015 CoSTR, all SysRevs were performed by the task forces. Since 2016, the process has involved several options for completing SysRevs; these options are outlined below.Knowledge Synthesis Units.ILCOR began a pilot program that commissioned internationally renowned groups of systematic-review methodologists who had completed a request for proposals to perform SysRevs. These groups had experience publishing high-quality SysRevs, and some adopted the name knowledge synthesis unit. The KSUs were commissioned to research evidence addressing particularly complex questions and multiple PICOSTs that usually involved more than 1 task force and to capture and analyze data to address multiple subgroup issues. The KSU staff worked in conjunction with content experts (as well as members of the CEE WG/SAC) who ensured that all relevant task forces were involved when questions were common to 2 or more of the task forces.The KSUs performed a commissioned review, based on contracts created with strict timelines for delivery. The KSU process included clear instructions about engagement of task force(s) and expectations for the final product, which included a peer-reviewed publication. Details are included in an online instructional document35 (see Table 1 summary for more details).Expert Systematic Reviewer.ILCOR invited expressions of interest for the ESR roles. These individuals or small collaborative groups were required to have methodological expertise and a track record of publications within the relevant domains. The appointed ESRs were then commissioned to perform SysRevs (see Table 1 for more details). The PICOSTs assigned to ESRs were less complex, with limited subgroup analyses, and usually involved a single task force. The first SysRev conducted by an ESR was published in 2018.36Task Force SysRev.The detailed KSU and ESR process for completion of SysRevs was commissioned by ILCOR with a contractual requirement to publish a SysRev in a peer-reviewed journal. The task forces, however, identified many topics that did not address complex questions or require extensive subgroup analyses. As in the ILCOR evidence evaluation processes through 2015, the ILCOR task forces were empowered to complete such reviews. If a topic was considered appropriate for a task force SysRev, the task force created a SysRev team and followed a formal process37 (see Table 2). The CoSTRs for these SysRevs are incorporated into the task force chapters. The supporting evidence-to-decision framework for each of the task force SysRevs is published in Supplement Appendix A. The first task force–based SysRev was published in 2020.38Table 2. Summary Outline of the Process Steps for the 2020 CoSTR SysRevsTask forces select, prioritize, and refine questions (using PICOST format)Task forces allocate level of importance to individual outcomesTask forces allocate PICOST question to SysRev team*SysRev registered with PROSPEROSysRev team works with information specialists to develop and fine-tune database-specific search strategiesRevised search strategies used to search databasesArticles identified by the search are screened by allocated members of the SysRev team using inclusion and exclusion criteriaSysRev team agrees on final list of studies to includeSysRev team agrees on assessment of bias for individual studiesGRADE Evidence Profile table createdDraft CoSTRs created by SysRev teamEvidence-to-decision framework completed by task forcePublic invited to comment on draft CoSTRsDetailed iterative review of CoSTRs to create final versionPeer review of final CoSTR documentCoSTR indicates Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; PICOST, population, intervention, comparison, outcome, study design, time frame; PROSPERO, International Prospective Register of Systematic Reviews; and SysRev, systematic review.* Systematic review team could be knowledge synthesis unit, expert systematic reviewer, or task-force-led team involving content experts from the International Liaison Committee on Resuscitation task force(s), and delegated member of the Continuous Evidence Evaluation Working Group and Scientific Advisory Committee.Adolopment.For some prioritized questions, the task force identified an existing, relevant, recently published SysRev (with or without a meta-analysis). The SAC recognized that duplication of effort to complete a new SysRev would be a waste of resources. For these situations, the CEE WG/SAC recommended use of the GRADE-Adolopment methodology39 to assess whether the identified review could be adopted and adapted as needed. This methodology includes a rigorous process with strict steps to allow the incorporation of the information into an ILCOR SysRev. The result of this process could be the construction of a CoSTR. This process was first used by the Advanced Life Support Task Force to review prophylactic antibiotic use after cardiac arrest.40,40a,41Components of a SysRevFormulating the Question.Existing and new questions for any SysRevs were formulated to comply with the population, intervention, comparison, outcome, study design42 and time frame. The CEE WG/SAC developed a generic template to facilitate the development of a sensitive and specific search strategy.43Search Strategy.The search strategies were created by information specialists on the basis of the PICOST question. Most of the searches were conducted by an information specialist contracted by ILCOR, while some were conducted by information specialists working with topic experts. Many of the search strategies themselves were independently peer reviewed. The CEE WG/SAC requested that the searches be performed, at a minimum, using MEDLINE, Embase, and the Cochrane Library. The CEE WG/SAC also requested a search of relevant databases of submitted protocols, to identify any incomplete or unpublished trials, and for the search to be registered with PROSPERO.Questions Related to Prognosis and Diagnostic Test Accuracy.Most topics reviewed by the task forces related to interventions, but some by necessity were focused on prognosis or diagnostic test accuracy. GRADE has formulated processes to support these,44,45 and the CEE WG/SAC provided guidance on outcome selection, tools for bias assessment, evidence profile tables, and variation in the evidence-to-decision framework. For some of the prognostic questions, the outcome measures used for diagnostic methodology (eg, specificity) were considered to have especially significant clinical relevance.46Combination of Data (Meta-Analysis).One reason to complete a SysRev is to facilitate the performance of meta-analyses. It is not always appropriate to combine data from identified studies, and reviewers were encouraged to consider the methodological rigor of the identified studies, and how similar they were with regard to components of the PICOST. If there were limitations to performing the meta-analysis (including heterogeneity), task forces were asked to describe these and to consider sensitivity analyses by including or excluding specific types of studies.19 The task forces were asked to state explicitly situations where the heterogeneity of studies precluded meta-analysis (eg, the nature of the results, the extent to which the results addressed the PICOST question, the methodology).GRADE ProcessGRADE was adopted by ILCOR for the 2015 evidence evaluation process.5,6 The GRADE process and ILCOR evidence evaluation have both continued to evolve, and a number of changes were made to the ILCOR evidence evaluation process to ensure consistency with the GRADE process. The GRADE risk-of-bias tools for randomized controlled trials and nonrandomized studies have changed, and the online guideline development tool has been updated. The GRADE developers continue to refine their processes, including improving ways to explain the published evidence.47 These updates were introduced through use of the online GRADE handbook22 and via specific publications.Key components of the GRADE process that were incorporated into the SysRevs completed for the 2020 ILCOR CoSTRs are listed below.Bias Assessment for Randomized Controlled Trials.The recommended risk of bias tool for randomized controlled trials is now the revised Cochrane Risk of Bias tool.48 This tool assesses the risk of bias using signaling questions to explore 5 domains for individually randomized trials, including bias arising from the randomization process, due to deviations from intended interventions, due to missing outcome data, in measurement of the outcome, and in selection of the reported result.Bias Assessment for Nonrandomized Trials.When using GRADE to evaluate certainty of evidence, the original certainty of evidence started at high for randomized controlled trials for interventions and started at low for observational (nonrandomized studies).49 As the types of evidence reviewed using the GRADE methodology expanded, some concern was expressed that the GRADE approach was unnecessarily harsh in its assessment of the certainty of the evidence.50 The GRADE group revisited this automatic allocation of evidence. The new recommended tool to assess risk of bias for nonrandomized studies was Risk of Bias In Non-randomised Studies - of Interventions (ROBINS-I).51 This tool enables all nonrandomized studies to start at low risk of bias, but it is expected that they will be adjusted to moderate, serious, or critical risk on the basis of methodological concerns.50Evidence Profile Tables.The GRADE evidence profile tables have been created to present a summary of the evidence that addresses the particular outcome. The ILCOR task forces continue to use the guidance from instructional documents on the ILCOR website, and the online GRADE guideline development tool52 to complete these tables. These tables include the following information: the specific outcome; the number of studies and their study design(s); judgments about risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias and factors that increase the certainty of evidence); relative and absolute effects for that outcome; a rating of the overall certainty of evidence for each outcome (which may vary by outcome); classification of the importance of each outcome; and explanatory footnotes, if needed. The use of these tables facilitates the translation of a body of science into a summary of science. The ILCOR task forces use the content of the evidence profile tables as a way to create the consensus on science statements. Wording may be: “For the critical outcome of survival to hospital discharge, we identified low-certainty evidence (downgraded for risk of bias and indirectness) from 3 randomized studies that enrolled 873 patients.” The evidence profile tables are not included in the task force chapter or appendices but are included in the SysRevs published in the peer-reviewed literature.Certainty (Quality) of Evidence.The GRADE process requires an allocation of the overall quality of the evidence identified to support each important or critical outcome. ILCOR adopted the phrase “certainty of evidence” as recently recommended by the GRADE working group.53 The ratings of the certainty of evidence reflect the extent of our confidence that the estimates of the effect are correct. This certainty of evidence, which is based on our confidence in the estimate of the relative importance of the outcomes (and their variability) is adequate to support a particular recommendation.54 The allocated certainty can be high, moderate, low, or very low (see Table 3).22Table 3. Certainty (Quality) of Evidence for a Specific Outcome (or Across Outcomes)22GradeDefinitionHighWe are very confident that the true effect lies close to tha

BACKGROUND:Post-cardiac arrest care is critically important in bringing cardiac arrest patients to functional recovery after the detrimental event. More high quality studies are published and evidence is accumulated for the post-cardiac arrest care in the recent years. It is still a challenge for the clinicians to integrate these scientific data into the real clinical practice for such a complicated intensive care involving many different disciplines.METHODS:With the cooperation of the experienced experts from all disciplines relevant to post-cardiac arrest care, the consensus of the scientific statement was generated and supported by three major scientific groups for emergency and critical care in post-cardiac arrest care.RESULTS:High quality post-cardiac arrest care, including targeted temperature management, early evaluation of possible acute coronary event and intensive care for hemodynamic and respiratory care are inevitably needed to get full recovery for cardiac arrest. Management of these critical issues were reviewed and proposed in the consensus CONCLUSION: The goal of the statement is to provide help for the clinical physician to achieve better quality and evidence-based care in post-cardiac arrest period.

Abstract Sudden out‐of‐hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. “All citizens of the world can save a life—CHECK—CALL—COMPRESS.” With these words, the International Liaison Committee on Resuscitation launched the 2019 global “World Restart a Heart” initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, “CHECK—CALL—COMPRESS,” will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) launched the first global “World Restart a Heart (WRAH)” initiative in 2018 — to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. Following a lobbying campaign by the European Resuscitation Council (ERC), the European Parliament passed a Written Declaration in June 2012 with a majority vote of 396 signatures calling for the establishment of European Cardiac Arrest Awareness Week. The ERC initially established the first European Restart a Heart day on 16th October 2013 — and since then every year on the same date. For 2018, ILCOR expanded the concept to its global network of resuscitation councils and renamed it ‘World Restart a Heart’. The following overarching principles were agreed1Böttiger B.W. Lockey A. Aickin R. et al.“All citizens of the world can save a life” — the World Restart a Heart (WRAH) initiative starts in 2018.Resuscitation. 2018; 128 (Epub 2018 April 19): 188-190https://doi.org/10.1016/j.resuscitation.2018.04.015Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar:1)WRAH Day will occur every year on 16 October.2)ILCOR will share resources and enthuse and motivate regional resuscitation councils to participate.3)Activity does not need to happen on 16 October, although that date will be used for media activity.4)Activity will not be limited to teaching school children, although some countries may wish to prioritise this.5)A dedicated website (www.ilcor.org/wrah) and media strategy will be developed. Swift bystander CPR can increase survival and favorable neurological outcome up to threefold in cardiac arrest victims.2Wissenberg M. Lippert F.K. Folke F. et al.Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.JAMA. 2013; 310: 1377-1384Crossref PubMed Scopus (788) Google Scholar If all countries had lay bystander resuscitation rates of at least 50%, hundreds of thousands of lives would be saved every year worldwide. All seven ILCOR councils actively participated in WRAH 2018, and they were joined by Councils representing India and also the Arabic Resuscitation Councils. To enable evaluation of the overall worldwide impact and measures of success, ILCOR asked all member councils and many National Resuscitation Councils (NRCs) to provide information about WRAH activities and estimate the numbers trained in CPR — with chest compression-only CPR training being the minimum requirement. Analysis of media metrics (e.g. reach of social media) enabled us to estimate the extent to which the message of WRAH had been disseminated as well as the number of lay people trained. The 2018 WRAH activity from around the globe is reported in Table 1.Table 12018 WRAH Activity.CouncilActivityAmerican Heart AssociationThe American Heart Association conducted a Hands Only CPR mobile tour throughout August and September ahead of WRAH Day, traveling to 5 states over 6 weeks with 18 stops. They trained 4801 people and all received a WRAH flyer. A further 10,908 people were trained later in 2018, and therefore, 15,709 people were trained in total.Arabic Resuscitation CouncilsHands only CPR training was performed for the public at shopping malls, for school students, and for University students and staff. Overall, 6000 people were trained in Saudi Arabia, 400 in Oman, 600 in Jordan, and 500 in Egypt.Australian and New Zealand Committee on ResuscitationIn Australia, 20,000 people were engaged in promotional activities with the personal support and a speech from Scott Morrison, the Australian Prime Minister. Events across the country were coordinated by the Council of Ambulance Authorities. In New Zealand, activities were organized by St. John and Wellington Free Ambulance Service. Sessions were held in schools, airports, and hospitals with an estimated 2150 people involved. The social media campaign, supported by the New Zealand and Australian Resuscitation Councils, reached 16,600 via Facebook and 15,000 via Twitter.European Resuscitation CouncilThe most impressive results for 2018 were reported from the United Kingdom, where CPR has become mandatory on the English school curriculum and 240,000 people were trained in CPR. In Poland, 116,342 were trained, in Germany 25,000, and in Italy 8,000. Overall, 410,000 people were trained in CPR in Europe during WRAH 2018. The European Society of Anaesthesiology (ESA) and the European Society of Emergency Medicine (EuSEM) have actively supported WRAH 2018.Heart and Stroke Foundation of CanadaTo compliment year-long training activities, the Heart & Stroke Foundation of Canada implemented a social media awareness campaign to specifically highlight WRAH. The campaign emphasized multiple messages relating to early response and survivor stories. Heart & Stroke distributed a campaign toolkit to stakeholders with tips, visuals and an invitation to engage online. The campaign generated high levels of engagement in Canada, including over 77,900 impressions across platforms. A how-to video on hands-only CPR video was viewed over 179,000 times in English and French.Indian Resuscitation CouncilThe Indian Resuscitation Council, members of the Indian Society of Anaesthesiologists, and other professional societies performed nationwide CPR training of laypeople in high schools, colleges, bus stations, railway stations, police stations, company offices, and other public places. At least 30 federal states of India participated and many Chief Ministers and Health Ministers were actively involved. Overall, 200,000 people were trained in India for WRAH 2018.InterAmerican Heart FoundationThe Inter American Heart Foundation reported activities in Peru and pledged improved engagement for WRAH 2019.Resuscitation Council of AsiaIn Japan, there were several promotions regarding CPR training, including the preparation of a CPR compulsory program for junior-high and high school students, with further consideration for the elementary school level. On WRAH Day, the “Many Nationalities in a CPR Training Session” program was implemented and 59 people from 36 embassies in Tokyo were invited to attend this event to raise public awareness about CPR. In South Korea, the Korean Association of CPR held its annual symposium attended by 400 researchers and educators. In Singapore, WRAH activities were supported by Senior Government Minister and 20,000 military personnel were trained in CPR. In Taiwan, mandatory CPR education in schools has been established for 18 years, and CPR rates have improved over that time from less than 4% to more than 40%. In Hong Kong, a joint WRAH awareness campaign was performed with Red Cross and St John Ambulance.Resuscitation Council of Southern AfricaA CPR week was performed in November. Around 1000 people were trained in CPR in disadvantaged areas where it takes a long time for emergency services to arrive. The Resuscitation Council of South Africa will align next year’s activities exactly to the WRAH date. Open table in a new tab Overall, social media impact and awareness with #WorldRestartaHeart reached over 12.7 million people in October 2018, and over 675,000 people were trained in CPR worldwide. We hope that our unified global WRAH message “CHECK – CALL – COMPRESS” will further enable our policy makers around the world to take action in this most important health care initiative. WRAH 2019 will be the next great opportunity for all citizens of the world to join together and show their respect and support for the promotion and facilitation of CPR education for everyone — “All that is needed is two hands.” Further information, videos, presentations, curricula and concepts on lay resuscitation initiatives, school children education in resuscitation and WRAH can be found here: www.ilcor.org/wrah www.erc.edu www.lifesaver.org.uk https://kids-save-lives.net/ www.grc-org.de https://www.ircouncil.it/ https://www.resus.org.uk www.einlebenretten.de www.wiederbelebung.de http://www.wosp.org.pl/uczymy-ratowac/rekord https://www.youtube.com/watch?v=0Yf4umHnD3c https://www.youtube.com/watch?v=UYlvdUcGjz0 https://www.youtube.com/watch?v=EDp4krk2--M http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2012-0266+0+DOC+XML+V0//EN www.heart.org/handsonlycpr https://youtu.be/sGXK9O5801Y https://www.nzrc.org.nz https://resus.org.au Bernd W. Böttiger is European Resuscitation Council (ERC) Board Director Science and Research; Associated Editor, European Journal of Anaesthesiology (EJA); Speakers honorarium from Medupdate, FoMF, Baxalta, Bayer Vital, Bard; Chairman, German Resuscitation Council (GRC); Board Member, German Society of Interdisciplinary Intensive Care and Emergency Medicine (DIVI); Associated Editor, Resuscitation. Maaret Castren is the Honorary Secretary of ILCOR. Lana Gent is employed by the American Heart Association. Andrew Lockey is Honorary Secretary of the Resuscitation Council (UK). Kevin Nation is employed as Chief Executive by the New Zealand Resuscitation Council. Robert W. Neumar is ILCOR Co-Chair and has received NIH research funding (R34 HL130738, R44 HL091606, K12 HL133304, R01 HL133129) and industry research support from PhysioControl (equipment support for laboratory and clinical research). Jerry Nolan is Chair of the ERC and Editor-in Chief of Resuscitation. Gavin Perkins is Co-Chair ILCOR and ERC Board Director ILCOR and Guidelines. Richard Aickin, Allan de Caen, Raffo Escalante, Karl B. Kern, Swee Han Lim, Vinay Nadkarni, David Stanton and Tzong-Luen Wang declared that they have no conflicts. All other authors did not stated any conflicts. We cordially thank all colleagues, ministers, politicians, teachers, women and men, children, organizations, medical societies und business entities who have supported and will support the ILCOR “World restart a heart” initiative and other initiatives all over the world. Bernd W. Böttiger and Gavin Perkins are supported by the ERC Research NET.

AIM:To systematically review the literature on advanced airway management during adult cardiac arrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations.METHODS:The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials and observational studies published before October 30, 2018. The population included adult patients with cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies.RESULTS:We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiac arrest. The risk of bias for individual observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. Three of the controlled trials, all published in 2018, were powered for clinical outcomes with two comparing a supraglottic airway to tracheal intubation and one comparing bag-mask ventilation to tracheal intubation. All three trials had some concerns regarding risk of bias primarily due to lack of blinding and variable adherence to the protocol. Clinical and methodological heterogeneity across studies, for both the observational studies and the controlled trials, precluded any meaningful meta-analyses.CONCLUSIONS:We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.