This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

requiring first aid, related education and implementation strategies, and systems of care. After the publication of the 2015 International Consensus on CPR and ECC Science With Treatment Recommendations, ILCOR also committed to sponsoring a continuous evidenceevaluation process, with topics prioritized for review by the task forces and with CoSTR updates published annually. For this 2020 CoSTR, the 6 ILCOR task forces performed structured reviews of 184 topics, completing the most ambitious evidence review that ILCOR has attempted to date.The ILCOR systematic review process continues to be based on the methodological principles published by the National Academy of Health and Medicine (formerly the Institute of Medicine) 2 ; Cochrane 3,4 ; Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 5 ; and the reporting guidelines based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. 6,7 Three types of evidence evaluation provided the basis for this 2020 CoSTR: the systematic review, the scoping review, and the evidence update. Based on recommendations from the ILCOR Scientific Affairs Committee and agreement of the task forces, only systematic reviews could result in new or modified treatment recommendations.

requiring first aid, related education and implementation strategies, and systems of care. After the publication of the 2015 International Consensus on CPR and ECC Science With Treatment Recommendations, ILCOR also committed to sponsoring a continuous evidenceevaluation process, with topics prioritized for review by the task forces and with CoSTR updates published annually. For this 2020 CoSTR, the 6 ILCOR task forces performed structured reviews of 184 topics, completing the most ambitious evidence review that ILCOR has attempted to date.The ILCOR systematic review process continues to be based on the methodological principles published by the National Academy of Health and Medicine (formerly the Institute of Medicine) 2 ; Cochrane 3,4 ; Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 5 ; and the reporting guidelines based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. 6,7 Three types of evidence evaluation provided the basis for this 2020 CoSTR: the systematic review, the scoping review, and the evidence update. Based on recommendations from the ILCOR Scientific Affairs Committee and agreement of the task forces, only systematic reviews could result in new or modified treatment recommendations.

ObjectiveTo determine the risk factors for extubation failure in the intensive care unit.MethodsThe present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation.ResultsOut of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02).ConclusionPediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.

Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and supported this P-COSCA initiative (Pediatric COSCA). The P-COSCA Steering Committee generated a list of potential survival, life impact, and economic impact outcomes and assessment time points that were prioritized by a multidisciplinary group of healthcare providers, researchers, and parents/caregivers of children who survived cardiac arrest. Then expert panel discussions achieved consensus on the core outcomes, the methods to measure those core outcomes, and the timing of the measurements. The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available.