Elsevier

Resuscitation

Volume 167, October 2021, Pages 151-159
Resuscitation

Review
A comparative evaluation and appraisal of 2020 American Heart Association and 2021 European Resuscitation Council neonatal resuscitation guidelines

https://doi.org/10.1016/j.resuscitation.2021.08.039Get rights and content

Abstract

Aim

The International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support forms the basis for guidelines developed by regional councils such as the American Heart Association (AHA) and the European Resuscitation Council (ERC). We aimed to determine if the updated guidelines are congruent, identify the source of variation, and score their quality.

Methods

We compared the approach to developing recommendations, final recommendations, and cited evidence in the AHA 2020 and ERC 2021 neonatal resuscitation guidelines. Two investigators scored guideline quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Results

Differences in the recommendations were found between AHA 2020 and ERC 2021 neonatal resuscitation guidelines. The councils gave differing recommendations for practices that had sparse evidence and made recommendations based on expert consensus or observational studies. AGREE II assessment revealed that AHA scored better for the domain ‘rigour of development’, but ERC had a higher score for ‘stakeholder involvement’. Both AHA and ERC scored relatively less for ‘applicability’.

Conclusion

AHA and ERC guidelines are predominantly based on the ILCOR CoSTR. Differences in recommendations between the two were largely related to the evidence gathering process for questions not reviewed by ILCOR, paucity of evidence for some recommendations based on existing regional practices and supported by expert opinion, and different interpretation or application of same evidence. Overall, both guidelines scored well on the AGREE II assessment, but each had domains that could be improved in future editions.

Introduction

Using the GRADE evaluation process, the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support forms the framework on which other neonatal resuscitation councils base their recommendations.1., 2., 3., 4., 5. Though most of the recommendations formulated by the different councils share a similar evidence base, some recommendations may vary.2., 3. This review aims to detail the differences between the updated ILCOR 2020 Consensus on Science and Treatment Recommendations (ILCOR 2020) for Neonatal Life Support, the American Heart Association (AHA 2020) neonatal resuscitation guidelines, and the European Resuscitation Council (ERC 2021) neonatal resuscitation guidelines and explores the reasons for such differences.1., 2., 3. Further, the quality of different domains of the AHA and ERC guidelines are evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II).6

Section snippets

Methods

The published approach to developing recommendations, the evidence gathering process, final recommendations, and cited evidence in the AHA 2020 and ERC 2021 neonatal resuscitation guidelines were compared with ILCOR CoSTR 2020.1., 2., 3. Further, the algorithms published with each of these guidelines were evaluated. The AGREE II instrument was used to evaluate the quality of AHA and ERC guidelines by two authors (VVR, TA).6 AGREE II includes 23 items organized into 6 quality domains. The

Guideline development process

ILCOR 2020 utilized three types of evidence evaluations including systematic reviews, evidence updates, and scoping reviews.1 ILCOR continued to utilize the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for evaluating the certainty of evidence (CoE) supporting interventions.8 Draft CoSTR statements are posted on-line for public comment before final review and approval. Whilst GRADE categorizes the CoE into 4 levels (high, moderate, low, very low), the

Discussion

Although the ILCOR CoSTR reflects consensus treatment recommendations developed by resuscitation experts who come from a variety of international resuscitation councils, our review identified differences between the recently published AHA and ERC neonatal resuscitation guidelines. Most of these differences were related to interventions supported by very low to low CoE or expert opinion. In addition, AGREE II scores for these two guidelines varied for several domains.

Both AHA and ERC have

Conclusions

The guidelines of AHA and ERC are predominantly based on the ILCOR CoSTR. The differences in recommendations between the two guidelines were largely related to the evidence gathering process for questions not reviewed by ILCOR CoSTR, a paucity of evidence for recommendations based on existing regional practices and supported by expert opinion, and different interpretation or application of the same evidence base. Overall, both guidelines scored well on the AGREE II assessment but had domains

Funding sources

None.

Author contributions

Daniele Trevisanuto, Gary M. Weiner and Viraraghavan Vadakkencherry Ramaswamy conceptualized the paper. Viraraghavan Vadakkencherry Ramaswamy and Thangaraj Abiramalatha did the quality appraisal of the guidelines and produced the initial draft. Daniele Trevisanuto and Gary M. Weiner provided further intellectual inputs and revised the first draft. All authors approved the final version of the manuscript submitted to the journal for peer review.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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