|
Citation
|
Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, Dickson S, Geduld H, Al-Hilali Z, Karki S, Lahri S, Maconochie I, Montealegre F, Mustafa MT, Niermeyer S, Odakha JA, Perlman JM, Monsieurs KG, Greif R, Aldakak F, Bhanji F, Breckwoldt J, Cheng A, Cortegiani A, Eastwood K, Farquharson B, Finn J, Gómez CA, Hsieh MJ, Lauridsen KG, Lockey A, Nabecker S, Nation K, Olaussen A, Sawyer T, Yang CW, Yeung J. Lancet Glob. Health 2023; 11(9): e1444-e1453. |
|
Abstract
|
Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide...
For this statement, the expert group discussed the various kinds of low-resource settings, such as the overall situation in a low-income country or in remote environments in high-income countries (eg, ships, oil platforms, spacecraft or aircraft, or Antarctic research stations), or acute resource-constrained situations (eg, as a result of natural disasters, pandemics, war, or other conflict areas). Naturally, every CPR situation in each of these settings means a fight for the life of a person, and all these situations deserve attention. Resuscitation efforts are also not limited to sudden cardiac death and early defibrillation, but embrace all causes of cardiac arrest and treatment options. Moreover, many of the topics that were discussed could be further dissected into cases of out-of-hospital and in-hospital cardiac arrest. However, as noted earlier, the group proposed that—for capacity reasons—this statement should not focus on specific situations leading to cardiac arrest, such as polytrauma and trauma, land mine incidents, or drowning (these situations should be revisited in the systematic review), but rather give a general overview and first foray into the subject matter. Most importantly, we do not want to imply that CPR is always the most important health-care topic and that scarce resources must be allocated away from other areas towards resuscitation efforts; other health-care issues (eg, clean drinking water, diseases such as malaria, trauma, and women's health) can often be much more pressing in the broader picture.
Existing and implemented initiatives
We acknowledge that there are already several existing and implemented efforts to improve emergency care or resuscitation programmes, such as the very successful initiatives of the Pakistan Life Savers Programme, the Helping Babies Breathe programme (a successful global initiative teaching essential neonatal and newborn resuscitation skills, predominantly in low-income and middle-income countries),30 the international effort against drowning,31, 32, 33, 34 and WHO programmes for the assessment of trauma care and emergency medical systems (eg, the WHO Basic Emergency Care course and the WHO Emergency Care System Framework).16, 35, 36, 37 The Helping Babies Breathe initiative was initially confronted with a scarcity of resources and structure, as is also the case with other resuscitation efforts. However, the programme's success through simple but effective interventions (eg, assessing and opening the individual's airway, providing ventilation, or keeping newborns warm) induced the necessary enthusiasm of local facilitators needed to trigger the support of local and international governmental organisations ...
Language: en |