Recent discussions
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ILCOR Staff
Nice work - well done to all involved. Clearly there is a need for further research to inform the management of hypoglycaemia in "individuals with altered mental status who are not able to swallow an orally administered form of glucose or sugar". However, I was wondering if it would be possible for ILCOR to make an 'expert consensus' recommendation re this ? -
ILCOR Staff
In the first treatment recommendation, the phrasing of "...without pausing chest compressions until a tracheal tube..." implies that following tracheal tube insertion, rescuers may still pause to deliver ventilations. Separating the sentence may help avoid ambiguity. Consider re-phrasing: "We recommend EMS providers perform CPR with 30 compressions to 2 ventilations until a tracheal tube or supraglottic device has been placed. Rescuers may also elect to perform continuous chest compressions with positive-pressure ventilations delivered without pausing chest compressions (strong recommendation, high quality evidence). -
ILCOR Staff
The study of Valdes et al did not compare the time to lidocaine or amiodarone administration and the defibrillation doses between both groups. These facts could influence the final results. A multicenter international study to compare lidocaine and amiodarone in children is necessary to obtain evidences. -
ILCOR Staff
I would suggest to interchange the order of the drugs in the Treatment Recommendation: we suggest Lidocaine or Amiodarone... The basis is that Lidocaine is that the limited evidences indicate an advantage for lidocaine in terms of ROSC and a possible trend in terms of survival. Although both are considered similar, the wording should consider these facts. -
Jasmeet Soar
Many thanks for the feedback from the JRC. In the presence of large RCTS of amiodarone and lidocaine (Kudenchuk 2016, Kudenchuk 1999, Dorian 2002) , a decision was made to exclude non RCTs at the start of the GRADE review. We are aware of the recent systematic review (Chowdhury 2018) - this review gave a point estimate based on combining both RCTs and non RCTs and we feel this is not appropriate. The available data for Nifekalant is very limited and any treatment recommendation would be speculative. The ILCOR treatment recommendation should not prevent the JRC from using Nifekalant based on its local values and preferences. Sincerely, Dr Jasmeet Soar, ALS TF Chair. -
Jasmeet Soar
Thanks for your comments. There are no RCTS that compared different dosing regimens of an antiarrhythmic drug in cardiac arrest. The dose recommendations will therefore be based on those used in RCTs. Kind regards Jasmeet Soar ALS Task Force chair -
Mayuki Aibiki
Dear friends:We are writing for your request of delivering JRC comments on CoSTR draft: antiarrhythmic drugs for cardiac arrest-adult. Please, kindly find our comments attached below.Hiroshi Nonogi, MD, PhD, FAHA, FJCC, FJCAToshikazu Funazaki MD, PhDMayuki Aibiki, MD, PhD Comment:The latest CoSTR draft has dealt with only RCTs including two Japanese studies of small number of OHCAs with shock-resistant VF. We are now raising recent systematic review (SR) including Japanese papers of non-RCTs describing the effects of nifekalant for OHCAs with refractory VF (ref.#3-7 as shown below). Total numbers of patients in such papers were 1532 in ref. #3-5; 317 in ref. #6.7. You should have already known that in the recent SR, there were no differences in ROSC, survival to admission, survival to discharge or neurological outcome in OHCA survivors between amiodarone and nifekalant; but in the comparisons between lidocaine and nifekalant, nifekalant demonstrated a significantly improved survival to admission (p=0.003), whereas no benefits in ROSC, survival to discharge or neurological outcomes. Reference1. Amino M, et al. Journal of cardiovascular pharmacology. 2010; 55: 391-8.2. Igarashi M, et al., Pacing Clin Electrophysiol. 2005;28 Suppl 1: S155-7.3. Harayama N, et al., J Anesth. 2014; 28: 587-92.4. Amino M, et. Al., Journal of cardiovascular pharmacology. 2015; 66: 600-9.5. Tagami T, et al., Resuscitation. 2016; 109: 127-132.6. Shiga T, et. al. Resuscitation. 2010; 81: 47-52.7. Tahara Y, et al., Circ J. 2006; 70: 442-6.8. Chowdhury A, et al., Heart Lung Circ. 2018; 27: 280-290. -
Saul Drajer
If amio and lido seem to be almost the same, we'll have to start looking for new drugs! Saul Drajer -
Kurt Anseeuw
Is there a difference in outcome in EMS systems where EMS-personnel is trained in using tracheal tube or supraglottic devices and EMS systems without these techniques ? -
Kurt Anseeuw
Nice work. Is there an effect of different dosing of antiarrhythmic drugs ?