Consensus on Science with Treatment Recommendations (CoSTR)
The point is that if there is no current evidence that hypothermia is better than normothermia, perhaps normothermia should be recommended, because is less aggressive, easier to perform and with fewer side effects. Hypothermia should be restricted to clinical trials.
Unfortunately there are not adequate data to perform a strong recommendation.
I think that the expertise in BMV, tracheal intubation and SGA probably coul be an important factor but it is very difficult to evaluate.
New studies should analyze not only tracheal intubation versus BMV, but BMV with continuous chest compressions or coordinated chest compression
The committee did an excellent job evaluating and summarizing the evidence. I like the new continuous review process and the opportunity for public comment--- my only recommendation for improving this process is to supplement the text with some figures. The sentences are repetitive with only slight changes in wording and it makes it difficult for the reader to maintain focus. Something like forest plots would help to supplement and summarize the excellent, albeit dense, text.
Is there any evidence about the use of mechanical ventilators in an intubated patient. As for now it seems logical that only in a volume controlled mode there is a guarantee that enough air is inflated. In a pressure regulated modus one can suppose that the high peak pressures of compressions inhalt the insufflations. However most volume controlled modes now also have a certain degree of pressure regulation. I think it would be good from a teaching point of view to have a clear statement on which is currently best practice as this frequently leads to discussions. Our current practice is to use a BVM attached to ET or SGA as you can feel the resistance and slowly inflate enough volume.
Minimally interrupted cardiac resuscitation should be practiced as the resources are minimum in OHCA . IHCA AND OHCA guidelines should be developed based on evidence based science , new devices and resource management of EMS system.
As many providers will read only the"treatment recomendation section" , I think is important to add to that section that it is related to "central" temperature. I mean it can be dangerous to interpret 37,5C as peripheral temperature, wich means fever "centrally".
After 30+ years teaching Paediatric Life Suppot Skills to new learners and experienced health care providers in medicine, nursing, dentistry and EMS, I can witness to the challenges of learning and maintaining intubation skills in non anesthesiologists. My interpretation of the Gauche study and some of Nadkani's work at CHOP would lead me to give a stronger reconmmendation for BVM versus intubation than this report.
I have shared the draft CoSTR with our local director of ECLS at Queensland Children's Hospital. He agrees with the statements. He suggested that the review includes the following papers - Resuscitation (2012) 83:710 & Circulation (2010) 122:S241 & Surgery Cong Heart Dis (2008) 136:984.