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The publication, in this issue of the
Middle East Journal of Emergency Medicine,
of the Arab Guidelines for Adult
Cardiopulmonary Resuscitation, reflects
the world wide consensus on science that
has been generated at the start of the new
millenium.
The Arab Guidelines, written by Professors
Takrouri and Seraj, reflect accurately
the principles agreed at the Guidelines
Conferences during 1999 and 2000 in Dallas.
Here participants from the United States,
Europe, Australia, Canada, Southern Africa,
Latin America, the Middle East and the
Orient evaluated and debated the scientific
evidence related to the resuscitation process.
Not all of resuscitation practice stands
up to careful scrutiny. Resuscitation
is, in many areas, still an imprecise
science. Accordingly studies and experience
were graded into different levels. These
range from Level I (randomised controlled
trials) to Level VIII (anecdotal reports
and time honored practice without scientific
evidence). Within these levels the evidence
was also sifted into excellent, good and
poor. Techniques, drugs and equipment
were also allocated into different classes.
Class I was supported by unequivocal,
excellent evidence of benefit ( e.g. early
dibrillation in ventricular fibrillation),
Class lIa was supported by very good evidence
of benefit (e.g. the laryngeal mask as
an airway adjunct) and Class lib by fair
evidence of benefit (e.g. the use of amiodarone
in refractory ventricular fibrillation).
Class III was determined to be detrimental
or ineffective (e.g. high dose adrenaline/epinephrine).
Class Indeterminate was applied to techniques,
drugs and equipment where there was insufficient
evidence to come to a conclusion (e.g
high frequency chest compression).
All topics were debated until a scientific
consensus was reached in principle and
then teams set about transfering the results
of the debate into print. The writing
and editorial process had a truly international
contribution.
The result was the International Guidelines
2000 for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care, a truly
formidable volume of some 450 pages, published
simultaneously in Resucitation [1] and
Circulation [2] in August 2000. This publication
represents the gold standard reference
work for all involved in the field of
resuscitation. Perhaps the title of the
book is somewhat misleading and gives
the wrong impression, for it is far more
than Guidelines; it contains the comprehensive
evidence upon which those guidelines were based.
Realising that a major textbook had
been produced, it was sensibly decided
that each country or region should produce
and publish their own succinct version
of the Guidelines, based on the common
science, but adapted to suit their own
values, style of practice and health care
systems. The European Resuscitation Council
(ERC) has produced its own Summary of
Guidelines and Sequence of Actions with
Algorithms. These have been published
in Resuscitation [3] and as a booklet
[4]. These publications supplement the
new ERC course manuals and other teaching
materials that are also based on the new consensus.
The Arab Guidelines published in this
issue follow a similar pattern, providing
a simple and easily readable document,
highlighting the key elements of the resuscitation
process in adults. They should, of course,
be read in conjunction with the chapters
in the full textbook which includes detailed
analysis of other subjects such as airway,
ventilation and circulation adjuncts,
first aid, post resuscitation care, special
circumstances and challenges in emergency
cardiovasculr care, acute coronary syndromes
and stroke, ethical aspects and paediatric
and neonatal resuscitation.
References:
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