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(Circulation. 2000;102:I-377.)
© 2000 American Heart Association, Inc.

Editorials

Guidelines Based on Fear of Type II (False-Negative) Errors

Why We Dropped the Pulse Check for Lay Rescuers

Richard O. Cummins, MD; Mary Fran Hazinski, RN, MSN

The new guidelines for CPR and ECC strongly emphasize evidence as the basis for all new clinical recommendations. The level of evidence may range from a high of Level 1 (one or more randomized, controlled clinical trials) to a low of Level 8 (rational conjecture, common sense, or accepted historically as standard practice). Nonevidence factors can influence the selection of the final class of recommendation, such as the expense of interventions, the ease of teaching, and the consequences of error. A technique that might improve resuscitation outcomes based on animal evidence, eg, open-chest CPR, turns out to be complex, difficult to learn, and difficult to implement. Such a technique would not merit as strong a recommendation as a technique that produced more modest improvements in survival but did so with superior ease of teaching, learning, and implementing.

Two principles that were less familiar to the International Guidelines 2000 experts came into play in several of the debates over the final class of recommendation:

• Avoid "false-negative" (type II) errors in patient assessment.
  
• Keep any risks from the interventions as close to zero as possible.
  

We have followed these principles in developing 3 new guidelines recommendations:

• Elimination of the pulse check for lay rescuers.
  
• Secondary confirmation techniques for tracheal tube placement. These are additions to current overreliance on physical examination as the best confirmation technique.
  
• More specific methods to prevent tracheal tube dislodgment.
  

As a general rule clinicians develop a strong imperative always to avoid what are called type II errors or . . . [Full Text of this Article]

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