Recent discussions
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Виктория Антонова
When assessing the effect of nasopharyngeal suction just after birth is that there are no measures of how much fluid is removed. This is an important knowledge gap. I question the use of Apgar score as a main outcome. Apgar score is very subjective and imprecise because it is recorded after the event and depends on the resuscitator's recall. The same people who are involved in the suction are giving the Apgar score. This is a major source of bias and should be mention in the assessments using Apgar score. The term SaO2 is used. However, that is the terminology for arterial oxygen saturation. Peripheral arterial oxygen saturation measurements are not just arterial oxygen. The correct term to use for measurements of peripheral arterial oxygen saturation is SpO2. -
Виктория Антонова
Thanks for the comment. We were aware of the secondary outcome survival in your study. The inclusion criteria defined in this systematic review every article that reports outcomes of technology engagement on OHCAs, without specifying if it is a primary or secondary outcome. Therefore, we used the outcomes form your study. Because such studies are not powered for secondary outcomes GRADE downgrades these studies in the risk of bias assessment. Despite of that, your results are a very important contribution in the field of first responders engagement with the help of modern technology. -
Виктория Антонова
Thank you -
Виктория Антонова
Thank you -
Виктория Антонова
Thanks you - this is up to the Individual Resuscitation Councils/ Healthcare systems involved in delivering tracing and training of CPR -
Виктория Антонова
Thanks for the encouraging comment, we will consider if your suggestions need to be included in the gap of knowledge. -
Виктория Антонова
Thanks for your insight, we agree fully with your wish for high stake multicenter trials. -
Виктория Антонова
Thanks for your comment about possible impact of no TOR rules on hospital transport of futile patients. That was the reason why we added a paragraph about that in the Justification chapter of this CoSTR. EIT will consider your suggestion for the gap of knowledge. -
Виктория Антонова
Thank you for your comment. We did not identify any human studies that directly compared the rate of drug infusion between humeral IO vs IV during cardiac arrest. As such, there is insufficient evidence for making any conclusions on this topic. -
Виктория Антонова
Thank you for your insightful comments. They underscore the lack of a standard uniform definition of cardiac activity. If the definition from Gaspari, et al. is considered the most user-friendly definition, then we encourage stakeholders and guideline organization to promulgate this definition so it can be uniformly used across investigations. This specific PICOST questions pertains to using POCUS for prognostication of clinical outcome during cardiac arrest. It is agnostic to POCUS as a diagnostic test for specific etiologies of cardiac arrest or POCUS as a means to assess hemodynamic response to therapy. Huis, et al. and Clattenburg, et al. are cited as a means to simply caution clinicians to not introduce additional interruptions in chest compressions with POCUS. We acknowledge the existence of several strategies to minimize interruptions in chest compressions. In response to this comment, we are adding additional language to the penultimate Evidence-to-Decision bullet point: Clinicians should be cautious about introducing additional interruptions in chest compressions with a transthoracic approach to point-of-care echocardiography during cardiac arrest. (Huis In’t Veld 2017 95, Clattenburg 2018 65). Several strategies to minimize these interruptions have been proposed. Additionally, we are adding additional clarifying language to the final print version of this CoSTR (pending publication in October, 2020). “Finally, in 2015 the question of whether the use of cardiac ultrasound during CPR changed outcomes was reviewed {Soar 2015 e71, Callaway 2015 s84}. This topic was not prioritized for an evidence update in 2020. The 2015 treatment recommendation currently remains pending further review: We suggest that if cardiac ultrasound can be performed without interfering with standard ACLS protocols, it may be considered as an additional diagnostic tool to identify potentially reversible causes (weak recommendation, very-low-quality evidence).”