Author response: A critique of the recent 2018 ERC CPR guidelines

摘要

Thankyou for the opportunity to reply to Dr Lederman's critique of the European Resuscitation Council (ERC) Guidelines for Resuscitation: 2018 Update - Antiarrhythmic drugs for cardiac arrest. Firstly, the ERC Guideline update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR) and a systematic review of all the available evidence rather than the results of a single randomised controlled trial. After reviewing all the available evidence, the ILCOR consensus was that there is very little difference between amiodarone and lidocaine, and we cannot be confident that one drug is better than the other for both critical outcomes such as survival to discharge with good neurological function, and important outcomes such as ROSC (return of spontaneous circulation). In the ERC 2018 guideline update some of the values and preferences discussed by the ILCOR Advanced Life Support Task Force are included. We believe it was right that those reviewing the science considered the pros and cons of firstly using an antiarrhythmic drug given the uncertain evidence about long-term outcomes and the potential benefits and harms of achieving ROSC, and the factors that will determine which drug is chosen (training, cost, availability).