Utstein-Style Guidelines for Uniform Reporting of Laboratory CPR Research: A Statement for Health Care Professionals From a Task Force of the American Heart Association, the American College of Emergency Physicians, the American College of Cardiology, the

The Writing Group for this statement comprised Ahamed H Idris, MD (chair); Lance B Becker, MD (cochair); Joseph P Ornato, MD; Jerris R Hedges, MD; Nicholas G Bircher, MD; Nisha C Chandra, MD; Richard O Cummins, MD, MPH; Wolfgang Dick, MD, PhD; Uwe Ebmeyer, MD; Henry R Halperin, MD; Mary Fran Hazinski, MSN, RN; Richard E Kerber, MD; Karl B Kern, MD; Peter Safar, MD; Petter A Steen, MD, PhD; M Michael Swindle, DVM; Joshua E Tsitlik, PhD; Irene von Planta, MD; Martin von Planta, MD; Robert L Wears, MD; and Max H Weil, MD. [Idris AH, Becker LB, Ornato JP, Hedges JR, Bircher NG, Chandra NC, Cummins RO, Dick W, Ebmeyer U, Halperin HR, Hazinski MF, Kerber RE, Kern KB, Safar P, Steen PA, Swindle MM, Tsitlik JE, von Planta I, von Planta M, Wears RL, Weil MH: Utstein-style guidelines for uniform reporting of laboratory CPR research: A statement for health care professionals from a task force of the American Heart Association, the American College of Emergency Physicians, the American College of Cardiology, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Institute of Critical Care Medicine, the Safar Center for Resuscitation Research, and the Society for Academic Emergency Medicine. Ann Emerg Med November 1996;28:527-541.] Both laboratory and clinical investigators contribute to the multidisciplinary knowledge base of resuscitation science. Although diversity can be a strength, it can also be a hindrance because of the lack of a common language and poor communication among investigators. Modern CPR research depends on the use of animal models that are designed to simulate cardiac arrest in human beings.1 and 2 Such models are used to explore important new treatments and to refine protocols used in standard interventions, including doses of drugs, chest-compression techniques, defibrillation energies, and cerebral resuscitation, before they are applied to human beings.3 When favorable results are reported in animal models, the new or refined techniques are often implemented soon afterward in human victims of cardiac arrest. Unfortunately, the results obtained in one laboratory may not be reproducible in another laboratory or in human trials. For example, high-dose epinephrine therapy significantly improves survival in most animal models of cardiac arrest but does not improve survival in humans.4, 5, 6 and 7 In addition, some animal studies have documented the efficacy of administering bicarbonate during cardiac arrest, whereas others have shown it to be ineffective or deleterious.8 Some of these differences are to be expected because an animal simulation is not a perfect model of cardiac arrest in humans. However, it is likely that some of these conflicting results are due to differences in experimental methods and laboratory model design. Variations in study design, such as the quality of chest compressions and ventilation, definitions of variables, or time intervals between an event and the beginning of therapy, are probably responsible for many of the inconsistencies and contradictions reported. The lack of standardization and the use of nonuniform terminology in reports of studies of cardiac arrest in humans have been described as a Tower of Babel.9 To address these problems, participants at a June 1990 international resuscitation conference concerned with out-of-hospital cardiac arrest research, held at the Utstein Abbey in Norway, met to discuss the lack of standardized nomenclature and language in research reports. A second meeting, the Utstein Consensus Conference, was held in December 1990 in Surrey, England, to continue the discussion, and recommendations, including uniform definitions and terms ("Utstein Style") to assist clinical investigators in reporting results of resuscitation studies in humans10 were developed and later published simultaneously in two American journals, in the journal of the European Resuscitation Council, and in major French and German journals. In a recent review of the literature, Idris et al11 examined four fundamental variables in animal resuscitation research: ventilation, the nonintervention interval (the duration of untreated cardiac arrest), measurement and production of blood flow during chest compressions, and the definition of return of spontaneous circulation. The investigators found a wide range of experimental methods and methods of reporting information and a conspicuous lack of uniformity in definitions of the four variables examined and other fundamental variables. It is clear that uniform guidelines for reporting data would be useful to investigators and would enhance communication within the field of CPR research. In 1990 the European Academy of Anaesthesiology offered preliminary guidelines for issues related to such investigations.12 That work provided the foundation for three international conferences organized to create guidelines for laboratory CPR research. At the first conference, held during the International Resuscitation Research Conference in Pittsburgh, Pennsylvania, in May 1994, participants identified issues related to experimental methods and methods of reporting laboratory CPR research and generated questions related to six main topics: (1) measurement and production of blood flow, (2) ventilation and acid-base conditions, (3) design of clinically appropriate protocols, (4) definitions and reporting, (5) defibrillation and induction of cardiac arrest, and (6) anesthetics and species differences. At the second conference, Utstein II: Setting Guidelines for Laboratory CPR Research, held in Chicago, Illinois, in October 1994, workshops corresponding to the six fundamental areas of laboratory CPR research were organized to develop uniform definitions and guidelines for reporting. The guidelines developed in this second conference were presented and discussed several days later at the Second CPR Congress of the European Resuscitation Council, held in Mainz, Germany. Participants at the three conferences represented 25 countries and the following eight organizations: the American College of Cardiology; the American College of Emergency Physicians; the American Heart Association; the European Resuscitation Council; the Heart and Stroke Foundation of Canada; the Institute of Critical Care Medicine; the Safar Center for Resuscitation Research, University of Pittsburgh; and the Society for Academic Emergency Medicine. This statement is the final consensus of these investigators regarding laboratory CPR research. It includes a glossary of terms and a template of features to describe when reporting laboratory studies of CPR.