Recent discussions
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David Zideman
Dear Simon. Thank you for your comment. The function of the ILCOR task force is to examine the published literature, produce a consensus on science (CoS) using GRADE methodology and then provide a treatment recommendation(TR) based on the consensus on science. We qualify our treatment recommendation with a values and preferences statement where we have further qualified the recommendation on swallowing. As with previous ILCOR CoSTR statements it is for the national councils to interpret the recommendation into local practice. -
ILCOR Staff
Considering the treatment recommendations will need to be implemented at the most rudimentary BLS level, the use of tablets (a hard choking block for someone with hypoglycaemic induced dysphagia) and despite oral vs buccal administration being faster (but not necessarily safer), where is the practical and evidence-based swallowing function test that should be central to this recommendation? So far it is subjective for people without clinical experience. Australia changed there guideline with no definitive test procedure, however I would expect ILCOR to be more rigorous in ensuring that mitigating one risk does not create another. -
ILCOR Staff
Dear Judith Thank you for your comment which the First Aid Task Force has considered carefully. This was a challenging review due to the limited number of studies to include, and the very low level of certainty of evidence. The First Aid Task Force use the accompanying GRADE Evidence to Decision tables and extensive discussion to help create an expert consensus recommendation appropriate for first aid providers caring for individuals with suspected hypoglycaemia (which is often accompanied by some degree of altered mental status) and who are able to swallow and follow commands. We will clarify the use of the Evidence to Decision framework for these recommendations in the Values and Preferences statement. For those individuals who are no longer able to swallow or follow commands, parenteral routes remain preferable, but a recommendation of which treatment or route would be outside the scope of the first aid task force. This will be reflected in the Values and Preferences section. -
ILCOR Staff
Specific characteristics of children should be considered -
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