| Sequence of Resuscitation |
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|---|---|
| Initiation of resuscitation | What are optimal strategies to enhance lay rescuer performance of CPR? |
| Metrics for high-quality CPR | What is optimal for the CPR duty cycle (the proportion of time spent in compression relative to the total time of the compression-plus-decompression cycle)? |
| Metrics for high-quality CPR | What is the validity and reliability of ETCO2 in nonintubated patients? |
| Metrics for high-quality CPR | For patients with an arterial line in place, does targeting CPR to a particular blood pressure improve outcomes? |
| Metrics for high-quality CPR | How does integrated team performance, as opposed to performance on individual resuscitation skills, affect resuscitation outcomes? |
| Defibrillation | Is there an ideal time in the CPR cycle for defibrillator charging? |
| Defibrillation | Can artifact-filtering algorithms for analysis of ECG rhythms during CPR in a real-time clinical setting decrease pauses in chest compressions and improve outcomes? |
| Defibrillation | Does preshock waveform analysis lead to improved outcome? |
| Defibrillation | Do double sequential defibrillation and/or alternative defibrillator pad positioning affect outcome in cardiac arrest with shockable rhythm? |
| Vascular access | Is the IO route of drug administration safe and efficacious in cardiac arrest, and does efficacy vary by IO site? |
| Vasopressor medications during cardiac arrest | Does epinephrine, when administered early after cardiac arrest, improve survival with favorable neurological outcome? |
| Nonvasopressor medications during cardiac arrest | Do antiarrhythmic drugs, when given in combination for cardiac arrest, improve outcomes from cardiac arrest with shockable rhythm? |
| Nonvasopressor medications during cardiac arrest | Do prophylactic antiarrhythmic medications on ROSC after successful defibrillation decrease arrhythmia recurrence and improve outcome? |
| Nonvasopressor medications during cardiac arrest | Do steroids improve shock or other outcomes in patients who remain hypotensive after ROSC? |
| Adjuncts to CPR | Does the use of point-of-care cardiac ultrasound during cardiac arrest improve outcomes? |
| Adjuncts to CPR | Is targeting a specific ETCO2 value during CPR beneficial, and what degree of rise in ETCO2 indicates ROSC? |
| Termination of resuscitation | Can ETCO2 be used for intra-arrest prognostication, in combination with other metrics? |
| Termination of resuscitation | Can point-of-care cardiac ultrasound, in conjunction with other factors, inform termination of resuscitation? |
| Advanced Techniques and Devices for Resuscitation |
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| Advanced airway placement | What is the optimal approach to advanced airway management for IHCA? |
| Advanced airway placement | There is a need for further research specifically on the interface between patient factors and the experience, training, tools, and skills of the provider when choosing an approach to airway management. |
| Advanced airway placement | What is the specific type, amount, and interval between airway management training experiences to maintain proficiency? |
| Alternative CPR techniques and devices | Which populations are most likely to benefit from ECPR? |
| Specific Arrhythmia Management |
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| Atrial fibrillation or flutter with rapid ventricular response | What is the optimal energy needed for cardioversion of atrial fibrillation and atrial flutter? |
| Bradycardia | What is the optimal approach, vasopressor or transcutaneous pacing, in managing symptomatic bradycardia? |
| Care After ROSC | |
| Postresuscitation care | Does avoidance of hyperoxia in the postarrest period lead to improved outcomes? |
| Postresuscitation care | What is the effect of hypocarbia or hypercarbia on outcome after cardiac arrest? |
| Postresuscitation care | Does the treatment of nonconvulsive seizures, common in postarrest patients, improve patient outcomes? |
| Postresuscitation care | What are the optimal pharmacological treatment regimens for the management of postarrest seizures? |
| Postresuscitation care | Do neuroprotective agents improve favorable neurological outcome after arrest? |
| Postresuscitation care | What is the most efficacious management approach for postarrest cardiogenic shock, including pharmacological, catheter intervention, or implantable device? |
| Postresuscitation care | Is there a role for prophylactic antiarrhythmics after ROSC? |
| Targeted temperature management | Does targeted temperature management, compared to strict normothermia, improve outcomes? |
| Targeted temperature management | What is the optimal temperature goal for targeted temperature management? |
| Targeted temperature management | What is the optimal duration for targeted temperature management before rewarming? |
| Targeted temperature management | What is the best approach to rewarming postarrest patients after treatment with targeted temperature management? |
| PCI after cardiac arrest | Does emergent PCI for patients with ROSC after VF/VT cardiac arrest and no STEMI but with signs of shock or electric instability improve outcomes? |
| Neuroprognostication | What is the interrater agreement for physical examination findings such as pupillary light reflex, corneal reflex, and myoclonus/status myoclonus? |
| Neuroprognostication | Can we identify consistent NSE and S100B thresholds for predicting poor neurological outcome after cardiac arrest? |
| Neuroprognostication | Are NSE and S100B helpful when checked later than 72 h after ROSC? |
| Neuroprognostication | Are glial fibrillary acidic protein, serum tau protein, and neurofilament light chain valuable for neuroprognostication? |
| Neuroprognostication | More uniform definitions for status epilepticus, malignant EEG patterns, and other EEG patterns are needed to be able to compare prognostic values across studies. |
| Neuroprognostication | What is the optimal timing for head CT for prognostication? |
| Neuroprognostication | Is there a consistent threshold value for prognostication for GWR or ADC? |
| Neuroprognostication | Standardization of methods for quantifying GWR and ADC would be useful. |
| Recovery |
|
| Recovery and survivorship after cardiac arrest | What do survivor-derived outcome measures of the impact of cardiac arrest survival look like, and how do they differ from current generic or clinician-derived measures? |
| Recovery and survivorship after cardiac arrest | Are there in-hospital interventions that can reduce or prevent physical impairment after cardiac arrest? |
| Recovery and survivorship after cardiac arrest | Which patients develop affective/psychological disorders of well-being after cardiac arrest, and are they treatable/preventable/recoverable? |
| Recovery and survivorship after cardiac arrest | Does hospital-based protocolized discharge planning for cardiac arrest survivors improve access to/ referral to rehabilitation services or patient outcomes? |
| Special Circumstances of Resuscitation |
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| Accidental hypothermia | What combination of features can identify patients with no chance of survival, even if rewarmed? |
| Accidental hypothermia | Should severely hypothermic patients receive intubation and mechanical ventilation or simply warm humidified oxygen? |
| Accidental hypothermia | Should severely hypothermic patients in VF who fail an initial defibrillation attempt receive additional defibrillation? |
| Accidental hypothermia | Should severely hypothermic patients in cardiac arrest receive epinephrine or other resuscitation medications? If so, what dose and schedule should be used? |
| Drowning | In what situations is attempted resuscitation of the drowning victim futile? |
| Drowning | How long after mild drowning events should patients be observed for late-onset respiratory effects? |
| Electrolyte abnormalities | What is the optimal treatment for hyperkalemia with life-threatening arrhythmia or cardiac arrest? |
| Opioid overdose | What is the minimum safe observation period after reversal of respiratory depression from opioid overdose with naloxone? Does this vary based on the opioid involved? |
| Opioid overdose | Is there benefit to naloxone administration in patients with opioid-associated cardiac arrest who are receiving CPR with ventilation? |
| Opioid overdose | What is the ideal initial dose of naloxone in a setting where fentanyl and fentanyl analogues are responsible for a large proportion of opioid overdose? |
| Opioid overdose | In cases of suspected opioid overdose managed by a non–healthcare provider who is not capable of reliably checking a pulse, is initiation of CPR beneficial? |
| Pregnancy | What is the ideal timing of PMCD for a pregnant woman in cardiac arrest? |
| Pulmonary embolism | Which patients with cardiac arrest due to “suspected” pulmonary embolism benefit from emergency thrombolysis during resuscitation? |
| Toxicity: β-adrenergic blockers and calcium channel blockers | What is the ideal sequencing of modalities (traditional vasopressors, calcium, glucagon, high-dose insulin) for refractory shock due to β-adrenergic blocker or calcium channel blocker overdose? |
| Toxicity: local anesthetics | What are the ideal dose and formulation of IV lipid emulsion therapy? |
| Toxicity: carbon monoxide, digoxin, and cyanide | Which patients with cyanide poisoning benefit from antidotal therapy? |
| Toxicity: carbon monoxide, digoxin, and cyanide | Does sodium thiosulfate provide additional benefit to patients with cyanide poisoning who are treated with hydroxocobalamin? |
ADC indicates apparent diffusion coefficient; CPR, cardiopulmonary resuscitation; CT, computed tomography; ECG, electrocardiogram; ECPR, extracorporeal cardiopulmonary resuscitation; EEG, electroencephalogram; ETCO2, end-tidal carbon dioxide; GWR, gray-white ratio; IHCA, in-hospital cardiac arrest; IO, intraosseous; IV, intravenous; NSE, neuron-specific enolase; PCI, percutaneous coronary intervention; PMCD, perimortem cesarean delivery; ROSC, return of spontaneous circulation; S100B, S100 calcium binding protein; STEMI, ST-segment elevation myocardial infarction; and VF, ventricular fibrillation.