Monash University, Department of Epidemiology and Preventive Medicine, Australia.
Liverpool Hospital, Intensive Care Unit, Australia; Macquarie University Hospitals, Intensive Care Unit, Australia; University of New South Wales and Macquarie University, Australia.
Resuscitation. 2021 Feb;159:137-149. doi: 10.1016/j.resuscitation.2020.10.001. Epub 2020 Oct 14.
We conducted a rapid review of current international and Australian advanced life support (ALS) guidelines for cardiac arrest associated with anaphylaxis to (1) assess the variation and (2) determine if a systematic review update of ALS guideline recommendations is warranted.
A search and comparison of key recommendations was conducted for major international and Australian clinical guidelines, including member societies and councils of the World Allergy Organisation and the International Liaison Committee on Resuscitation (ILCOR). Systematic database searches (Medline, Cochrane Database of Systematic Reviews, PROSPERO international register of systematic reviews and ClinicalTrials.gov databases) was conducted to identify existing and in-progress research published on the topic of anaphylaxis and cardiac arrest.
Eight international guidelines were identified from Australia/New Zealand, Europe, United States and Canada, and 5 national guidelines were identified for Australia. There was general consensus across all guidelines for the use of adrenaline, oxygen, patient positioning and glucagon. There was variation across international and Australian guidelines for adrenaline dosing and frequency, antihistamines and corticosteroid recommendations. Most recommendations were based on low-level evidence, and the review of published systematic reviews and clinical trials identified new evidence in the last decade.
We found significant variation between current ALS guideline recommendations for treating anaphylaxis. While there is no new evidence to suggest a systematic review of guideline recommendations is needed, there may be an opportunity to produce more consistent international guideline recommendations and educational materials.
我们对当前国际和澳大利亚与过敏反应相关的心脏骤停的高级生命支持 (ALS) 指南进行了快速审查，以评估其变化，并确定是否有必要对 ALS 指南建议进行系统审查更新。
对主要国际和澳大利亚临床指南中的关键建议进行了搜索和比较，包括世界过敏组织和复苏国际联络委员会 (ILCOR) 的成员协会和理事会。对过敏和心脏骤停相关主题的现有和正在进行的研究进行了系统的数据库搜索（Medline、Cochrane 系统评价数据库、PROSPERO 国际系统评价注册处和 ClinicalTrials.gov 数据库）。
从澳大利亚/新西兰、欧洲、美国和加拿大确定了 8 项国际指南，以及澳大利亚的 5 项国家指南。所有指南都普遍同意使用肾上腺素、氧气、患者体位和胰高血糖素。国际和澳大利亚指南在肾上腺素剂量和频率、抗组胺药和皮质类固醇建议方面存在差异。大多数建议基于低水平证据，对已发表的系统评价和临床试验的审查在过去十年中发现了新证据。
我们发现治疗过敏反应的当前 ALS 指南建议之间存在重大差异。虽然没有新的证据表明需要对指南建议进行系统审查，但可能有机会制定更一致的国际指南建议和教育材料。
