Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines

Current cardiac arrest guidelines have limited high-quality scientific evidence to support recommendations for care. The quality of scientific evidence on which guidelines are based may correlate with improved patient outcomes and meaningful survival. We sought to develop a prioritized list of knowledge gaps in resuscitation to assist researchers, policy makers, and funding agencies in their decision-making process.

A 4-stage modified Delphi method was used with a panel of cardiac arrest experts. Experts addressed the prompt: "What are the top 3 gaps in knowledge involving cardiac arrest care that should be research priorities for National Institutes of Health/American Heart Association funding to have the greatest impact on public health?" Knowledge gaps were identified in the initial round, rated in a second round, and rank ordered in the third round, and they underwent final review and consensus (final round). The outcome was 10 knowledge gaps, with prioritization of the top 3 gaps. A total of 61 gaps, with 19 distinct themes, were identified by participants. The 10 knowledge gaps most likely to affect public health identified by the expert panel included, in order, the following: telecommunicator cardiopulmonary resuscitation, hemodynamic monitoring for goal-directed resuscitation, reasons why bystanders fail to respond, optimization of postarrest care, out-of-hospital cardiac arrest identification and response, individualizing resuscitation strategies, predicting patients at risk, tools for neuroprognostication, optimal airway management, and optimizing educational strategies.

Ten priorities for cardiac arrest research were identified, but consensus was not reached on the prioritized top 3. Future research should address these gaps to potentially improve resuscitation guideline evidence quality.