Overview of the 2018 AHA Guidelines Focused Updates
Introduction to ILCOR and CEE Process
In 2015, the International Liaison Committee on Resuscitation (ILCOR) initiated a Continuous Evidence
Evaluation (CEE) process to enhance the speed of integrating new resuscitation research into guidelines.
The CEE process allows for rapid analysis of peer-reviewed studies, leading to the development of International
Consensus on CPR and ECC Science With Treatment Recommendations (CoSTR).
The goal is to minimize the time between the publication of new evidence and its incorporation into guidelines
by organizations like the AHA and Heart & Stroke Foundation of Canada.
Annual updates are published based on ILCOR CoSTR summary statements, ensuring that guidelines reflect the
latest research findings.
The 2018 updates focus on advanced cardiovascular life support (ACLS) and pediatric advanced life support
(PALS) recommendations.
Systematic Review and Task Force Contributions
ILCOR conducts systematic reviews to address specific resuscitation questions prioritized by expert task forces.
The 2018 review focused on the use of antiarrhythmic drugs for shock-refractory ventricular fibrillation (VF) or
pulseless ventricular tachycardia (pVT).
Task forces analyze and debate studies, leading to draft CoSTR statements that are made available for public
comment.
Final CoSTR summaries are published in reputable journals like Circulation and Resuscitation, ensuring
transparency and community engagement.
The AHA ACLS and PALS writing groups carefully consider these recommendations in the context of available
resources and training for both lay rescuers and healthcare providers.
Classification System for Recommendations and Levels of Evidence
Overview of AHA Classification System
The AHA uses a structured classification system to categorize the strength of recommendations and the quality
of evidence supporting them.
Recommendations are classified into three main classes: Class I (Strong), Class II (Moderate/Weak), and Class III
(No Benefit/Harm).
Each class is further divided into levels of evidence (LOE) ranging from A (high-quality evidence) to C (limited
data or expert opinion).
This system helps clinicians understand the reliability of the recommendations and the evidence behind them.
, Detailed Classification and Evidence Levels
Class I (Strong): Benefit >>> Risk
- High-quality evidence from multiple randomized controlled trials (RCTs).
- Recommended for use in clinical practice.
Class IIa (Moderate): Benefit >> Risk
- Moderate-quality evidence from well-designed studies.
- Reasonable to use in clinical practice.
Class IIb (Weak): Benefit ≥ Risk
- Evidence is less definitive; may be considered based on clinical judgment.
Class III: No Benefit/Harm: Risk > Benefit
- Interventions that are not recommended due to potential harm.
Key Recommendations from the 2018 Updates
Use of Antiarrhythmic Drugs During Resuscitation
The 2018 guidelines reaffirm that magnesium should not be routinely used for cardiac arrest, but may be
considered for torsades de pointes.
The focus is on the administration of antiarrhythmic drugs during CPR or immediately after return of
spontaneous circulation (ROSC).
The guidelines emphasize the importance of timing and sequence of interventions during resuscitation,
although optimal sequences remain unclear.
Clinicians are encouraged to consider individual patient circumstances and care environments when applying
these recommendations.
Research and Evidence Evaluation
The systematic review included literature up to August 15, 2017, focusing on outcomes such as survival to
hospital discharge and neurologic outcomes.
The review did not address the optimal sequence of interventions, highlighting a gap in current research.
Future studies are needed to clarify the timing of medication administration in relation to CPR and shock
Introduction to ILCOR and CEE Process
In 2015, the International Liaison Committee on Resuscitation (ILCOR) initiated a Continuous Evidence
Evaluation (CEE) process to enhance the speed of integrating new resuscitation research into guidelines.
The CEE process allows for rapid analysis of peer-reviewed studies, leading to the development of International
Consensus on CPR and ECC Science With Treatment Recommendations (CoSTR).
The goal is to minimize the time between the publication of new evidence and its incorporation into guidelines
by organizations like the AHA and Heart & Stroke Foundation of Canada.
Annual updates are published based on ILCOR CoSTR summary statements, ensuring that guidelines reflect the
latest research findings.
The 2018 updates focus on advanced cardiovascular life support (ACLS) and pediatric advanced life support
(PALS) recommendations.
Systematic Review and Task Force Contributions
ILCOR conducts systematic reviews to address specific resuscitation questions prioritized by expert task forces.
The 2018 review focused on the use of antiarrhythmic drugs for shock-refractory ventricular fibrillation (VF) or
pulseless ventricular tachycardia (pVT).
Task forces analyze and debate studies, leading to draft CoSTR statements that are made available for public
comment.
Final CoSTR summaries are published in reputable journals like Circulation and Resuscitation, ensuring
transparency and community engagement.
The AHA ACLS and PALS writing groups carefully consider these recommendations in the context of available
resources and training for both lay rescuers and healthcare providers.
Classification System for Recommendations and Levels of Evidence
Overview of AHA Classification System
The AHA uses a structured classification system to categorize the strength of recommendations and the quality
of evidence supporting them.
Recommendations are classified into three main classes: Class I (Strong), Class II (Moderate/Weak), and Class III
(No Benefit/Harm).
Each class is further divided into levels of evidence (LOE) ranging from A (high-quality evidence) to C (limited
data or expert opinion).
This system helps clinicians understand the reliability of the recommendations and the evidence behind them.
, Detailed Classification and Evidence Levels
Class I (Strong): Benefit >>> Risk
- High-quality evidence from multiple randomized controlled trials (RCTs).
- Recommended for use in clinical practice.
Class IIa (Moderate): Benefit >> Risk
- Moderate-quality evidence from well-designed studies.
- Reasonable to use in clinical practice.
Class IIb (Weak): Benefit ≥ Risk
- Evidence is less definitive; may be considered based on clinical judgment.
Class III: No Benefit/Harm: Risk > Benefit
- Interventions that are not recommended due to potential harm.
Key Recommendations from the 2018 Updates
Use of Antiarrhythmic Drugs During Resuscitation
The 2018 guidelines reaffirm that magnesium should not be routinely used for cardiac arrest, but may be
considered for torsades de pointes.
The focus is on the administration of antiarrhythmic drugs during CPR or immediately after return of
spontaneous circulation (ROSC).
The guidelines emphasize the importance of timing and sequence of interventions during resuscitation,
although optimal sequences remain unclear.
Clinicians are encouraged to consider individual patient circumstances and care environments when applying
these recommendations.
Research and Evidence Evaluation
The systematic review included literature up to August 15, 2017, focusing on outcomes such as survival to
hospital discharge and neurologic outcomes.
The review did not address the optimal sequence of interventions, highlighting a gap in current research.
Future studies are needed to clarify the timing of medication administration in relation to CPR and shock
