Part 2: International collaboration in resuscitation science: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

With the founding of the International Liaison Committee on Resuscitation (ILCOR) in 1992, an international collaboration of clinicians and researchers was convened to identify, evaluate, and interpret the most valid resuscitation science. This supplement to Circulation (simultaneously published in Resuscitation) presents the results of ILCOR’s most recent and extensive efforts to reach consensus on interpretation of resuscitation science and treatment recommendations. ILCOR continues to strive to reach a common goal of universal resuscitation guidelines. Building on the 2005 International Consensus on CPR and ECC Science With Treatment Recommendations,1,2 the 2010 International Consensus Conference held in Dallas, Texas, in February 2010 involved 313 experts from 30 countries. During the 2 years leading up to this conference, over 350 worksheet authors reviewed several thousand relevant, peer-reviewed publications to address more than 400 specific resuscitation questions, each in standard PICO (Population, Intervention, Comparison, Outcome) format. The experts reviewed, summarized, and categorized several thousand relevant, peerreviewed publications into level of evidence grids, proposed consensus on science statements, and where possible, provided evidence-based treatment recommendations.3 Key knowledge gaps were also identified and documented, with the purpose of stimulating further research in those areas. Ultimately scientific consensus was achieved by continuous discussion and debate in multiple face-to-face meetings and webinars, and finally through focused discussions of the evidence evaluation worksheets during the 3 days of the International Consensus Conference. Particular attention was paid to recognizing applicable advances in resuscitation science, while managing potential conflicts of interest among participants and identifying topics that lacked good evidence to support or change current practice. The year 2010 marks the 50th Anniversary of cardiopulmonary resuscitation (CPR). The original reports of rescue breathing,4 closed-chest compressions,5 and the effective combination of the two6 created an immediate demand for CPR training and resuscitation guidelines. In 1966, the Institute of Medicine (in the United States) convened the first conference to specifically review available evidence and to recommend standards for CPR and emergency cardiovascular care (ECC) techniques.7 The American Heart Association (AHA) sponsored subsequent conferences in 1973 and 1979.8,9 Parallel efforts occurred internationally as other resuscitation organizations faced a growing demand for CPR training.10 Inevitably variations in resuscitation techniques and training methods began to emerge from countries and regions of the world. Increasing awareness of these variations in resuscitation practices sparked interest in gathering international experts at a single location with the aim of achieving consensus in resuscitation techniques. The AHA convened such a meeting in 1985, inviting resuscitation leaders from many countries to observe the process by which the AHA reviewed evidence to create guidelines for CPR and ECC.11 Observation by these international guests, many of whom were passionately devoted to improving resuscitation outcomes in their own countries, soon led to the realization that much could be learned from international collaboration. By 1992, when the AHA convened their next Guidelines Conference, more than 40% of the participants were from outside the United States.12 During this 1992 conference, a panel on international cooperation on CPR and ECC endorsed the need to foster a multinational base of evidence for resuscitation practices. What was lacking was a focused and structured mechanism with which to capture and assess this growing body of published evidence. That panel strongly recommended that an expanded group of international experts initiate a systematic review of the world’s resuscitation