Note: Save worksheet using the following filename format: Taskforce. Topic. Author. Date. Doc where Taskforce is a=acls, b=bls, p=Pediatric, n=neonatal and i=Interdisciplinary. Use 2 or 3 letter abbreviation for author’s name and 30Jul03 as sample date format
Скачать 350.2 Kb.
|
REMEMBER TO SAVE THE BLANK WORKSHEET TEMPLATE USING THE FILENAME FORMAT WORKSHEET for PROPOSED Evidence-Based GUIDELINE RECOMMENDATIONS NOTE: Save worksheet using the following filename format: Taskforce.Topic.Author.Date.Doc where Taskforce is a=ACLS, b=BLS, p=Pediatric, n=neonatal and i=Interdisciplinary. Use 2 or 3 letter abbreviation for author’s name and 30Jul03 as sample date format.
STEP 1: STATE THE PROPOSAL. State if this is a proposed new guideline; revision to current guideline; or deletion of current guideline. Existing guideline, practice or training activity, or new guideline: Revise the guideline concerning vasopressin use in pediatric cardiac arrest: Data are insufficient to recommend the use of vasopressin in children with cardiac arrest (level indeterminate). Step 1A: Refine the question; state the question as a positive (or negative) hypothesis. State proposed guideline recommendation as a specific, positive hypothesis. Use single sentence if possible. Include type of patients; setting (in- /out-of-hospital); specific interventions (dose, route); specific outcomes (ROSC vs. hospital discharge). Vasopressin leads to better outcome from paediatric cardiac arrest than epinephrine. Step 1B: Gather the Evidence; define your search strategy. Describe search results; describe best sources for evidence. Pubmed search on following terms: Vasopressin and cardiac arrest, ventricular fibrillation, resuscitation, asystole and children (MeSH term and textwords) "Vasopressins"[MeSH] AND "Heart Arrest"[MeSH]: 94 hits "Vasopressins"[MeSH] AND "Cardiopulmonary Resuscitation"[MeSH] 95 hits "Vasopressins"[MeSH] AND "Cardiopulmonary Resuscitation"[MeSH] AND "Child"[MeSH] 5 hits Pubmed search ‘Vasopressin AND cardiac arrest’ – 137 hits Pubmed search ‘Vasopressin AND cardiac arrest’ – 13 hits Pubmed search ‘Vasopressin AND resuscitation’ – 244 hits Pubmed search ‘Vasopressin AND resuscitation and children’ – 18 hits Pubmed search ‘Vasopressin AND ventricular fibrillation’ – 87 hits Pubmed search ‘Vasopressin AND ventricular fibrillation and children’ – 4 hits Pubmed search ‘Vasopressin AND resuscitation and asystole’ – 77 hits Pubmed search ‘Vasopressin AND asystole and children’ – 11 hits Embase search 'vasopressin'/exp AND cardiac AND arrest AND 'children'/exp AND [1980-2004] : 4 hits 'vasopressin'/exp AND 'resuscitation'/exp AND [abstracts]/lim AND [embase]/lim AND [2000-2004] - 141 hits 'vasopressin'/exp AND cardiac AND arrest AND 'resuscitation'/exp AND [abstracts]/lim AND [1980-2004] 81 hits 'vasopressin'/exp AND 'resuscitation'/exp AND 'children'/exp AND [abstracts]/lim AND [1980-2004]/ 10 hits 'vasopressin'/exp AND cardiac AND arrest AND 'children'/exp AND [abstracts]/lim AND [1980-2004]/3 hits Cochrane Library 1 hit List electronic databases searched (at least AHA EndNote 7 Master library [http://ecc.heart.org/], Cochrane database for systematic reviews and Central Register of Controlled Trials [http://www.cochrane.org/], MEDLINE [http://www.ncbi.nlm.nih.gov/PubMed/ ], and Embase), and hand searches of journals, review articles, and books. Cochrane database (reviews and trials), Medline, Embase, references from previous articles and review articles. • State major criteria you used to limit your search; state inclusion or exclusion criteria (e.g., only human studies with control group? no animal studies? N subjects > minimal number? type of methodology? peer-reviewed manuscripts only? no abstract-only studies?) Citations were excluded if they were not true cardiac arrest models (eg. shock, liver trauma, cardiopulmonary bypass) if animal studies used vasopressin in resuscitation without comparison between vasopressin and adrenaline Human and animal adult studies were not excluded as pediatric studies were so scarce that extrapolations from adult studies could be interesting. Special focus on pediatrics for conclusions • Number of articles/sources meeting criteria for further review: Create a citation marker for each study (use the author initials and date or Arabic numeral, e.g., “Cummins-1”). . If possible, please supply file of best references; EndNote 6+ required as reference manager using the ECC reference library. 219 articles retrieved; 170 articles excluded for the following reasons: not true cardiac arrest models (eg. shock, liver trauma, other purpose with the use of vasopressin as only resuscitation drugs, cardiopulmonary bypass etc.)55; Vasopressin was compared to saline or placebo but not to adrenaline (8), reviews (106) or abstracts (1) In the pediatric field only: 18 articles with cases series (1); Animals research ( 3) Reviews (14) Articles Reviewed Animal Studies: 42; Human Studies Included English, German, and French languages, peer reviewed manuscripts, no abstracts STEP 2: ASSESS THE QUALITY OF EACH STUDYStep 2A: Determine the Level of Evidence. For each article/source from step 1, assign a level of evidence—based on study design and methodology. |
