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(Circulation. 1997;95:2172-2173.)
© 1997 American Heart Association, Inc.

Articles

Advisory Statements of the International Liaison Committee on Resuscitation

Richard O. Cummins, MD; Douglas A. Chamberlain, MD, Cochairs

Key Words: AHA Medical/Scientific Statements • cardiopulmonary resuscitation

	Introduction

Top Introduction

 
The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide a forum for liaison between principal resuscitation organizations worldwide. Although the criteria for participation were not closely defined, member organizations were expected to have an accepted remit for creating resuscitation guidelines, preferably for more than one country, and to be multidisciplinary in membership. At present, ILCOR comprises representatives of the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian Resuscitation Council (ARC), the Resuscitation Councils of Southern Africa (RCSA), and the newly formed Council of Latin America for Resuscitation (CLAR).

The AHA published standards for resuscitation in 1974. They were updated under the new designation guidelines—which better reflected their purpose—in 1980, 1986, and 1992. A number of national councils in Europe followed the American lead by introducing their own guidelines, which were eventually consolidated by the ERC in 1992. The motive was to make widely available throughout the continent a system for resuscitation that was perceived as matching more closely the needs of countries in Europe, most of which were less developed in this discipline than North America. Different traditions in the use and availability of drugs also predicated a modified approach. Increasingly these have been accepted as an appropriate model within Europe and have become well established. Similar developments took place in Australia and Southern Africa.

While the emergence of new organizations with a remit for resuscitation widened interest and expertise, there were some clear disadvantages. In particular, the various recommendations for conducting resuscitation were perceived as reflecting different approaches, whereas all were—inevitably—similar in substance. The apparent discrepancies flowed principally from differences in presentation. For example, the American guidelines were comprehensive and therefore used complex algorithms, whereas the European version placed more emphasis on simplicity. While all organizations appreciated the merits of each approach, they also agreed that emphasis on a common core of practice was desirable.

An opportunity for improved international cooperation was afforded by the AHA during its guidelines conference in 1992. Twenty-eight percent of invitees had come from outside the United States, and 42 countries were represented. A session in the conference was devoted to international issues, with 12 panelists participating. In the months that followed, plans were drawn up for the formal creation of an international liaison committee, and an inaugural meeting was held at an ERC symposium in England later the same year.

Other international initiatives were occurring at the same time, notably the movement toward common methods of presentation for the results of resuscitation, leading to the Utstein system of reporting. Cooperation was thereby strengthened and made more secure.

The committee adopted the name International Liaison Committee on Resuscitation, commonly known by the abbreviation ILCOR, with the following mission statement:

To provide a consensus mechanism by which the international science and knowledge relevant to emergency cardiac care can be identified and reviewed. This consensus mechanism will be used to provide consistent international guidelines on emergency cardiac care for basic life support (BLS), pediatric life support (PLS), and advanced life support (ALS). While the major focus will be upon treatment guidelines, ILCOR will also address the effectiveness of educational and training approaches and topics related to the organization and implementation of emergency cardiac care. ILCOR will also encourage coordination of dates for guidelines development and conferences by various national resuscitation councils. These international guidelines will aim for a commonality supported by science for BLS, PLS, and ALS.

Representation on ILCOR is the prerogative of the constituent councils rather than of individuals. Financial constraints and the need for continuity have dictated that only a limited number of representatives have taken part in the meetings. These have been held twice each year since 1992, usually alternating between a venue in America and a venue in Europe. Participation is limited to six representatives attending from the AHA, six from the ERC, three from the ARC, three from the RCSA, and one from the HSFC. The CLAR will have up to three representatives in the future. Plenary sessions for all participants have been a feature of all the meetings, but detailed work has been carried out by the working groups on BLS, ALS, and PLS (with neonatal).

ILCOR has the objective of working toward establishing common (global) guidelines. To this end, the meetings have examined the evidence on which existing recommendations are based and graded them using the system adopted by the AHA:

Class I (definitely helpful)

Class IIa (probably helpful)

Class IIb (possibly helpful)

Class III (inconclusive, possibly harmful)

While wishing to encourage the use of only Class I recommendations, this is seen to be impractical; few measures used in resuscitation are this well founded. Indeed, ILCOR has adopted a pragmatic approach. Until such time as new science is available, changes to standard practices will not be made without due cause. Some important modifications, however, have been suggested on educational rather than scientific grounds. But the need for all recommendations to be based on sound scientific evidence is well recognized and remains the goal.

ILCOR does not wish to subvert in any way the autonomy of its constituent bodies, and its publications should be regarded as advisory statements and as a resource based on a common science that has been carefully reviewed. Different practices adopted in the past by the constituent bodies have been widely discussed. The advisory statements have been drafted by participants who are regarded as at least some of the international opinion leaders. The statements have undergone many revisions over a lengthy period of time. The likelihood must be therefore that they represent a very good distillation of the state of the art existing at the present time.

It is hoped that the constituent organizations—and others who have a responsibility for making recommendations on resuscitation—will make use of this resource so that all future guidelines will reflect the commonality of opinion that has evolved during the process. Some differences will inevitably persist; variations in drugs and their usage still exist from one part of the world to another, and there are traditions that cannot be set aside overnight. But hopefully algorithms will be published in a manner that reflects similarities of opinion rather than differences.

The establishment of global guidelines is a viable goal, and we believe the current initiative has made major progress to this end. Continual international cooperation has other advantages. These include a stronger appreciation of resuscitation research carried out in other parts of the world and written in other languages, a keener sense of the shortcomings of our present knowledge base, an increased determination to improve the science of resuscitation, and the possibility of worldwide participation in multicenter studies that can bring this about more speedily.

This document presents the first ILCOR advisory statements. It is intended for consideration by expert national and international bodies, but the contents should not necessarily be promoted for use in their existing format.

	Footnotes

 
`Advisory Statements of the International Liaison Committee on Resuscitation' was approved by the American Heart Association Science Advisory and Coordinating Committee in February 1997.

A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596. Ask for reprint No. 71-0110. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or . To make photocopies for personal or educational use, call the Copyright Clearance Center, 508-750-8400.

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