Clinician Article

2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary.

  • Soar J
  • Donnino MW
  • Maconochie I
  • Aickin R
  • Atkins DL
  • Andersen LW, et al.
Circulation. 2018 Dec 4;138(23):e714-e730. doi: 10.1161/CIR.0000000000000611. (Review)
PMID: 30571263
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  • Pediatric Emergency Medicine
    Relevance - 7/7
    Newsworthiness - 6/7
  • Cardiology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Hospital Doctor/Hospitalists
    Relevance - 6/7
    Newsworthiness - 6/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Pediatrics (General)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Respirology/Pulmonology
    Relevance - 6/7
    Newsworthiness - 5/7


The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria. The statements include consensus treatment recommendations approved by members of the relevant task forces. Insights into the deliberations of each task force are provided in the Values and Preferences and Task Force Insights sections. Finally, the task force members have listed the top knowledge gaps for further research.

Clinical Comments

Hospital Doctor/Hospitalists

Useful analysis of evidence-based resuscitation practices. It has an important update on use of lidocaine. Hopefully, at least some of the unanswered questions will be addressed in the next summary.

Internal Medicine

This is a piece of very useful evidence. The article includes treatment recommendations with the most recent CPR science. This summary addresses the role of antiarrhythmic drugs. The knowledge gaps for further research are also mentioned.

Pediatric Emergency Medicine

This paper provides a statement and contains the final wording of the CoSTR that is based on Task Force analysis of the data and uses the Grading of Recommendations. This addresses many knowledge gaps in cardiopulmonary resuscitation, particularly amiodarone or lidocaine and magnesium in adults with shock-refractory VF/pVT.

Pediatrics (General)

In a 2018 consensus statement on the science of resuscitation, the committee looked particularly at the use of anti-arrhythmics in cardiac arrest. This did not result in a change from current guidelines that recommend either amiodarone or lidocaine for shock-refractory pulseless VT or VF. Although evidence is of marginal quality (for a variety of reasons), there is no change in the recommendation for either adults or children. There may have been a trend toward better outcomes with lidocaine over amiodarone in children, but not adults. Other drugs reviewed - magnesium, bretyllium, nifekalant and sotolol - were clearly of no benefit.


Critical review of studies using anti-arrhythmic drugs during cardiac arrest. The recommendations should set the standard for management of cardiac arrest as well as highlighting areas in need of further study.

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