Why the study?
Following an extensive evidence review by the International Liaison Committee on Resuscitation after the 2010 guidelines, updated recommendations for post-cardiac arrest care were needed for medical care delivery in North America.
What post-cardiac arrest care interventions and prognostic strategies improve survival and neurologic outcomes or accurately predict poor neurologic recovery in adult patients with return of spontaneous circulation after cardiac arrest?
What post-cardiac arrest care interventions and prognostic strategies improve survival and neurologic outcomes or accurately predict poor neurologic recovery in adult patients with return of spontaneous circulation after cardiac arrest?
This 2015 AHA Guidelines Update establishes evidence-based standards for post-cardiac arrest care, expanding targeted temperature management targets to 32°C–36°C for all rhythms, recommending against prehospital cold IV fluid boluses, and standardizing delayed multimodal neurologic prognostication.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Although, targeted temperature management is strongly recommended for neuroprotection in patients who remain comatose after resuscitation from a cardiac arrest, this recommendation is based on weak evidence of benefit, mostly from earlier trials that had many limitations.”
“Despite these limitations, the American Heart Association guidelines call for starting all comatose adult patients with return of spontaneous circulation after cardiac arrest on TTM with a target temperature between 32°C and 36°C maintained for at least 24 hours.”
Expands TTM range and standardizes delayed multimodal prognostication post-arrest; reinforces consensus and extends 2010 ILCOR guidelines with GRADE synthesis.
Introduction The recommendations in this 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are based on an extensive evidence review process that was begun by the International Liaison Committee on Resuscitation (ILCOR) after the publication of the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations and was completed in February 2015. In this in-depth evidence review process, ILCOR examined topics and then generated a prioritized list of questions for systematic review. Questions were first formulated in PICO (population, intervention, comparator, outcome) format, and then search strategies and inclusion and exclusion criteria were defined and a search for relevant articles was performed. The evidence was evaluated by the ILCOR task forces by using the standardized methodological approach proposed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. The quality of the evidence was categorized based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). Then, where possible, consensus-based treatment recommendations were created. To create this 2015 Guidelines Update, the AHA formed 15 writing groups, with careful attention to manage conflicts of interest, to assess the ILCOR treatment recommendations and to write AHA treatment recommendations by using the AHA Class of Recommendation (COR) and Level of Evidence (LOE) system. The recommendations made in the Guidelines are informed by the ILCOR recommendations and GRADE classification, in the context of the delivery of medical care in North America. The AHA writing group made new recommendations only on topics specifically reviewed by ILCOR in 2015. This chapter delineates instances where the AHA writing group developed recommendations that are significantly stronger or weaker than the ILCOR statements. In the online version of this publication, live links are provided so the reader can connect directly to the systematic reviews on the Scientific Evidence Evaluation and Review System (SEERS) website. These links are indicated by a combination of letters and numbers (eg, ALS 790). We encourage readers to use the links and review the evidence and appendixes, including the GRADE tables. This update uses the newest AHA COR and LOE classification system, which contains modifications of the Class III recommendation and introduces LOE B-R (randomized studies) and B-NR (nonrandomized studies) as well as LOE C-LD (limited data) and LOE C-EO (consensus of expert opinion). All recommendations made in this 2015 Guidelines Update, as well as in the 2010 Guidelines for post‒cardiac arrest care, are listed in the Appendix. For further information, see “Part 2: Evidence Evaluation and Management of Conflicts of Interest” in this 2015 Guidelines Update.
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Callaway et al. (2015) studied Post-cardiac arrest. Post-cardiac arrest care interventions (including emergent coronary angiography, targeted temperature management between 32°C and 36°C for at least 24 hours, hemodynamic optimization, and multimodal neurologic prognostication) was evaluated on Survival to hospital discharge and neurologically favorable outcome. The 2015 AHA Guidelines recommend emergent coronary angiography for suspected cardiac arrest with ST-elevation and targeted temperature management between 32°C and 36°C for comatose adult survivors.
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