38 Classification across all studies for each outcome Publication Bias Undetected Strongly suspected Quality of Evidence across all included studies for outcome High Moderate Low Very Low
39
40
41 Quality of evidence for outcome (across all studies) Four final categories High Moderate Low Very low Start with “high” for RCTs Start with “low” for observational Can be modified according to a number of factors
42 RCTs can be downgraded all or most of the studies had sufficient problems to make estimate unreliable or uncertain design and execution (risk of bias) consistency of results directness of comparisons precision publication bias
43 Overall quality of evidence: for each key outcome across studies
44 What about even lower levels of evidence? Case series (LOE 4) Manikin/Models/Animals (LOE 5)
45 Case series Start at low/very low quality Can be upgraded
46
47 Case series Start at low quality Can be upgraded BUT not if would be downgraded first!
48
49 Manikin/Models/Animals (LOE 5) (NB. GRADE not created for these) Starting point depends on methodology RCTs at high quality Observational at low quality BUT Even RCTs can be downgraded Very serious “indirectness” = -2 Can be explained in comments
50 Summary of Findings table: columns PICO Key Outcomes Illustrative comparative risks (categorical or continuous with 95% CI) Control group Intervention group Relative effect (95% CI) No of Participants (studies) Overall quality of the evidence (GRADE) Comments/Footnotes
51 Summary of findings table Present a key summary graph or table Citation #1 Citation #2
52 Next = CoSTR Consensus on Science statement and Treatment Recommendations
53 Differences between processes 2010 2015 Consensus on Science Consensus on Science statement (based on listing statement (based on “overall quality” of of levels of evidence for evidence for “critical specific outcomes) outcomes”) Treatment recommendation: using behavioral wording, Treatment recommendation: based largely on quality of strong or weak (with evidence behavioral correlates), based on evidence quality (high, moderate, low, very low)
54 So how will our Consensus on Science statement and Treatment Recommendations differ? COS: Quality level of evidence (GRADE) TR: Strength of Recommendation (GRADE)
55 GRADE Strength of Recommendation Strong: the desirable effects of an intervention clearly outweigh the undesirable effects, or clearly do not. Weak: the trade-offs are less certain — either because of low quality evidence or because evidence suggests that desirable and undesirable effects are closely balanced.
56 Strong Recommendation For patients — most people in your situation would want the recommended course of action and only a small proportion would not; request discussion if the intervention is not offered For clinicians — most patients should receive the recommended course of action
57 Weak Recommendation For patients — most people in your situation would want the recommended course of action, but many would not For clinicians — you should recognize that different choices will be appropriate for different patients and that you must help each patient to arrive at a management decision consistent with her or his values and preferences
58 So what might a GRADE review for ILCOR look like?
59 In adult cardiac arrest (prehospital [OHCA], in-hospital [IHCA]), does the use of an ITD (I) compared with no ITD (C), improve any outcomes (e.g. survival) (O)? Worksheet identifier: TBA Author: Peter Morley Affiliation: ANZCOR Taskforce: ALS/BLS Other Worksheet Authors: TBA
60 C2015 PICO Population : adult cardiac arrest (prehospital [OHCA], in-hospital [IHCA]) Intervention : the use of an ITD Comparison : compared with no ITD Outcomes Neurologically intact survival (critical 9) Discharge from hospital alive (critical 8) Return of spontaneous circulation (important 6)
61 Inclusion/Exclusion/Articles Found Included all studies with concurrent controls. Excluded review articles, studies with historical controls, animal studies, and studies that did not specifically answer the question. Excluded unpublished studies, studies only published in abstract form, unless accepted for publication. 8 Articles Finally Evaluated
62 Risk of Bias in studies table(s) Impedance Threshold Device + Standard CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment Intention to Treat which these of bias for (IT) analysis assessments apply outcome(s) for study** Aufderheide 2005, 734 Low Low Low Low Discontinued early. All Low ITD+SCPR vs ShamITD+SCPR Indirectness: 2000 guidelines. Pirallo 2005, 13 Low Unclear Low Low Changed device halfway into All Low ITD+SCPR vs ShamITD+SCPR study. Equipment problems Indirectness: 2000 guidelines. Aufderheide 2011, 798 Low Low Low Low Indirectness: 2005 guidelines All Low ITD+SCPR vs ShamITD+SCPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Active Compression Decompression CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Plaisance 2000, 989 Low Low Low Low No description primary All Low ITD+ACD vs ACD outcome/power. Indirectness: 1992 guidelines Plaisance 2004, 265 Low Low Low Low Automatic ventilator. All Low ITD+ACD vs ShamITD+ACD Indirectness: 2000 guidelines. Plaisance 2005, 990 Low Low Low Low Crossover trial. All Moderate ITD+ACD vs ShamITD+ACD (order of Indirectness: 2000 guidelines use) Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 63 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 64 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 65 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 66 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 67 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 68 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 69 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 70 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 71 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
Risk of Bias in studies table: 72 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Study Random Allocation Blinding Loss to follow-up, Any other risks Outcomes to Overall risk -ization concealment IT principle which these of bias for observed or per assessments apply outcome(s) protocol analysis for study** Wolcke 2003, 2201 Low High High Low Indirectness: ?1992/2000 All High ITD+ACD vs SCPR guidelines Aufderheide 2011, 301 Low Unclear High Unclear, some High: Significant differences in All High ITD+ACD vs SCPR (only exclusions based on real time feedback about CPR outcome difficultly with quality. Increase enrollment assessor) airway border on numbers then stop early. deviation from IT analysis.
73 Next create an “Evidence Profile” table
Evidence profile table: 74 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis) Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 75 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis) Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 76 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 77 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 78 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 79 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 80 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 81 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 82 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 83 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
84
85
86 Overall quality of evidence: for each key outcome across studies
Evidence profile table: 87 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 1 1 RCT Very No serious No serious Serious Undetected Low (rated Neurologically intact Aufderheide 2011 serious limitations limitations limitations (sponsor down for survival 301 limitations (ARR CI involvement). risk of bias (survival to hospital (blinding, overlap 1%) More and discharge with feedback pulmonary imprecision) modified Rankin ≤ 3) about CPR oedema I Critical (9) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
88
Evidence profile table: 89 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 90 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 91 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 92 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 93 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 94 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 95 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 96 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
Evidence profile table: 97 ITD+ACDCPR vs Standard CPR Impedance Threshold Device + Active Compression Decompression CPR (I) vs Standard CPR (C) Population: � Patients� in� cardiac� arrest� Settings: � OOHCA� Intervention: � Impedance� Threshold� Device� +� Active� Compression� Decompression� CPR� Comparison:� Standard� CPR� Outcome No of studies Study Risk of Inconsistency* Indirectness* Imprecision* Other (including Quality of st page Author Year 1 Design bias* publication evidence for bias)** outcome*** Outcome 2 2 RCT Very No serious Serious Serious Undetected Low (rated Survival to hospital Aufderheide 2011 serious limitations limitations limitations (sponsor down for discharge 301 limitations (Wolcke 2003 (ARR CI involvement) risk of bias, Critical (8) Wolcke 2003 2201 (blinding, 2210: overlap 1%) More indirectness feedback 1992/2000 pulmonary and about CPR guidelines) oedema I imprecision) quality, 94/840 (11%) vs exclusions/ C 62/813 (7%) IT 0.015. analysis)
98 Next create a “summary of findings” table
99
100 Summary of findings table(s) Present a key summary graph or table Citation #1 Citation #2
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