71 - Consensus development in resuscitation: the growing movement towards international emergency cardiovascular care guidelines

Summary

Introduction

Clinical guidelines aredefinedby the Institute ofMedicine in the United States as“systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” The main objective of guidelines is to improve the quality of care received by patients by closing the gap between what clinicians do and what scientific evidence supports. Guidelines provide a point of referencefor auditing performanceof clinicians or hospitals and may improve effectiveness and efficiency. The development of guidelines requires appropriate resources: expert clinicians, group process leaders, and financial support. All these statements refer to guideline development in general, but they are particularly relevant to the development of resuscitation guidelines that have existed for at least 40 years. The steps involved in the process for developing evidence-based guidelines have been outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group (Table 71.1).

This chapter will review the history of consensus development in resuscitation, the role of the International Liaison Committee on Resuscitation (ILCOR), the process involved in undertaking a systematic review of resuscitation science, and the writing of clinical guidelines based on a consensus of the science.

The history of international CPR consensus and guideline development

The modern approach to cardiopulmonary resuscitation (CPR) was described in the late 1950s and early 1960s. Although this was undoubtedly the birth of CPR, it was immediately realized that the challenge was to spread the word and educate healthcare workers and laypeople throughout the world. This same challenge faces us today whenever CPR guidelines are modified and updated.