2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Abstract

The 2020 Korean Post-cardiac Arrest Care Guidelines are medical recommendations derived based on scientific evidence for post-cardiac arrest care. These guidelines are based on the 2020 scientific consensus and treatment recommendations of the International Liaison Committee on Resuscitation and we additionally considered the research papers in the post-cardiac arrest care field which were published after the International Liaison Committee on Resuscitation review [1,2]. In these guidelines, topics which are clinically important and needed further consideration were reviewed in the form of adaptation or hybridization. Meta-analyses or scoping reviews for additional PICOs (Population, Intervention, Control, Outcomes) were also performed. The level of evidence (LOE) used the definition of the American Heart Association. It was divided into level A, the highest level, to level C, the lowest level [3]. Details are as follows. Level A is a LOE based on one or more high-quality randomized controlled studies, a meta-analysis of results of high-quality randomized controlled trials (RCTs), or one or more randomized controlled studies from a high-quality registry. Level B-R (randomized) is a LOE based on one or more moderate quality randomized controlled studies or a meta-analysis of results of randomized controlled studies with moderate quality. Level B-NR (non-randomized) is a LOE based on one or more well-performed non-randomized observational studies or moderate quality evidence from a well-performed registry, well-performed randomized observational studies, or meta-analysis results from registry studies. Level C-LD (limited data) is a LOE based on a RCT or a non-random observational study. This level is based on results of studies with limitations in study design and implementation, randomized controlled studies, non-random observational studies, or meta-analysis results of studies with limitations in study design and implementation as registry studies, or physiological or mechanical studies in human. Level C-EO (expert opinion) is based on consensus opinion of experts. The recommendation grade was judged on the basis of direction (benefit and harm) and strength (strong recommendation and weak recommendation) based on the recommendation in the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Classification is divided into three categories used by the American Heart Association [3,4]. Class I is when the benefit of the care or intervention is very high relative to the risk (it is appropriate for most physicians to provide care or intervention to most patients). Class IIa is when a care or intervention is generally useful (with some important exceptions, it is appropriate for most physicians to provide care or intervention). Class IIb is when a care or intervention has a positive effect, although the evidence is not clear. Class III (no benefit) is when care or intervention is ineffective (it is the case when high-level studies have not demonstrated efficacy). Class III (harm) is when a care or intervention has a higher risk than benefits (in case of harm). Compared to the 2015 guidelines, changes made in the 2020 guidelines are as follows.