The International Liaison Committee on Resuscitation has initiated a near-continuous review (Continuous Evidence Evaluation; CEE) of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. Until recently, the International Liaison Committee on Resuscitation (ILCOR) cardiopulmonary resuscitation (CPR) science review process has been undertaken in 5-year cycles, the last being published in 2015. This batch-and-queue approach had the advantage of enabling a well-planned and systematic update of guidelines and training materials. However, this presented a potential delay in the implementation of new effective treatments. The CEE process provides an opportunity to systematically review the science around PICO questions and produce an annual series of International Consensus on Science with Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year.
Frequently Asked Questions
Q: Where can I go to review the 2010 ILCOR evidence evaluation worksheets?
A: To access the digital worksheets through the 2015 Consensus on Science Circulation publication links, please follow these steps:
- Review the Circulation publication(link opens in new window)(link opens in new window)
- Select the link for the worksheet topic of interest
- On arrival at AHA landing page for Consensus on science, sign in using the tab on the top right-hand corner
- Return to the AHA landing page for Consensus on science and click on the digital link to worksheet which is under the second header on the landing page
Q: What is a PICO question?
A: PICO is an acronym that stands for “Population, Intervention, Comparator, Outcome”. A PICO is expressed as a question such that a specific point of interest in evidence-based practice may be framed and an answer sought.
Q: What is the difference between a PICO and a PICOST?
A: A PICO is the portion of the process wherein a question is asked. PICOST has the addition of ‘S’ for Study type (e.g. randomized control trials) and a ‘T’ to denote the Timeframe from which the studies are taken (e.g. 1995-2015).
Q: What is a SR?
A: The SR is a systematic review of the scientific literature which enables informed answers to the question posed by a PICO(ST). It is published separately from the Consensus on Science with Treatment Recommendations (CoSTR).
Q: What is a CoSTR?
A: CoSTR is an acronym for Consensus on Science with Treatment Recommendations wherein the experts in the respective field of study give consensus-informed recommendations for treatment. Each task force within ILCOR will produce a CoSTR for any given systematic review.
Q: After the PICOs are examined and prioritized, what is the next step?
A: There are a number of steps that occur once a PICO question has been taken on by a task force:
Continuous Evidence Evaluation Process
Priority PICO question is confirmed
Task force, domain lead, and CEE WG or SAC confirm PICO to be completed for systematic review.
- Task force appoints 2 content experts
If a PICO question involves more than 1 task force, a content expert is assigned from each task force.
- ESR team and ILCOR priority team draft PICOST
This ILCOR team consists of content experts, CEE WG liaison, domain lead, and information specialist.
- CEE WG modifies and approves PICOST and sends to ILCOR board
Content expert confirms content.
- Time zero begins
Task force and ILCOR board acknowledge PICOST receipt, and KSU or ESR begins systematic review.
- GRADE evidence review is conducted
KSU, or ESR and SRM, assesses data by using GRADEpro and completes GRADE analysis.
- Consensus on Science is drafted
KSU, or ESR and SRM, drafts Consensus on Science by using data from GRADE analysis.
- CoSTR is developed
Content experts, domain lead, and relevant task force compose CoSTR draft, which is posted on costr.ilcor.org for public comment.
Q: Is this where the new Guidelines focused updates are written?
A: No. ILCOR produces recommendations not guidelines. Each member council reviews these recommendations and updates their respective guidelines.
What about conflicts of interest?
Both ILCOR and the AHA have conflict of interest policies that are consistent with "best in industry" standards. Everyone involved with the 2015 International CoSTR Conference was required to complete and sign a Conflict of Interest Questionnaire.
Every Conflict of Interest Questionnaire is reviewed by the AHA and potential significant conflicts of interest are further reviewed by a Conflict of Interest Task Force. ILCOR and the AHA consider conflict of interest of the utmost importance in maintaining the integrity of the evidence evaluation process and have made every good faith effort to resolve any real conflicts of interest among conference participants.
ILCOR carefully contemplates scientific knowledge gaps and clinical research priorities identified during the continuous evidence evaluation process with the understanding that they may inform new research considerations. Since 2015, knowledge gaps for topics of review are included in each Consensus on Science with Treatment Recommendations.