2024 ILCOR CoSTR Summary

Supplementary Tables

Neonatal Life Support Supplementary Table

Table S1. Summary of Recommendations for Umbilical Cord Management in Infants <37
weeks’ gestation
Gestation Circumstances Recommendation Certainty Strength of
group of recommendation
Evidence
<37 weeks Immediate Recommend defer clamping the Moderate Strong
resuscitation at cord for at least 60 sec.
birth not
required
<37 weeks Immediate Insufficient evidence to make a Low Weak
resuscitation recommendation
required
<37 weeks Maternal, fetal, Insufficient evidence – make Very low Weak
placental individualized decisions
conditions that
were excluded
from many
studies*
Further treatment suggestions
28+0 to Suggest umbilical cord milking, Low Conditional
36+6 Deferred cord taking into account maternal
weeks clamping not and infant circumstances
<28 weeks received Suggest do not milk the intact Low Weak
cord

First Aid Supplementary Tables: Characteristics of Included Articles in ScopRev of Use

of Supplementary Oxygen in First Aid

Table S2: Carbon Monoxide Poisoning

Author; Study Settin Popula Interven Compa Outcome Results/Key findings

Year Type g tion tion rison s
Publishe
d
Smith Retrosp Preho Accide Oxygen, No Delirium, Mostly epidemiological
19701 ective spital ntal oxygen supple persistent study. Found fewer
case and and carbon mentar psychiatri persistent symptoms if
series hospit deliber dioxide y c oxygen administered,
al ate mixture, oxygen symptoms advised oxygen carbon
emerg carbon hyperba dioxide mixture if
ency monoxi

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 2024 ILCOR CoSTR Summary

depart de ric hyperbaric oxygen not

ments (CO) oxygen available.
poisoni
ng
(N=206
)
Winter Literatur Pre- Person 100% Not Reversal Authors recommended
19762 e review and in- s with oxygen specifie of 100% oxygen at
hospit carbon as first d hypoxemi atmospheric or
al monoxi aid, a and hyperbaric pressures to
de hyperba accelerat reverse hypoxemia and
poisoni ric ed accelerate CO
ng oxygen eliminatio elimination.
in n of CO
hospital
Olson Literatur Pre- Person 100% Not Time to Recommends 100%
19843 e review and in s with oxygen specifie resolution oxygen as soon as
hospit carbon as soon d of carbon monoxide
al monoxi as neurologi poisoning suspected,
de possible cal and using a tight-fitting mask
poisoni , neuro- to deliver the highest
ng multiple psychiatri percent oxygen.
non-first c
aid symptoms

Koster Literatur Pre- Person 100% None Not The authors recommend
20034 e review and in s with oxygen, specified administration of 100%
hospit carbon recompr oxygen.
al monoxi ession
de chamber
poisoni if
ng availabl
e

Kao Literatur Pre- Person Supple None Not Authors recommend

20061 e review and in s with mentary specified supplemental oxygen and
hospit carbon oxygen other supportive care.
al monoxi and
de hyperba
poisoni ric
ng oxygen

Jüttner Evidenc Pre- Person 100% None Not Authors recommend

20215 e based and in s with oxygen specified immediate administration
guidelin hospit carbon of oxygen at the highest
e al monoxi available concentration.
de
poisoni
ng

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 2024 ILCOR CoSTR Summary

Table S3: Diving Emergencies

Author; Study Setti Popula Interven Compa Outcome Results/Key findings

Year Type ng tion tion rison s
Publish
ed
Dick Retrospe Pre- Scuba 100% No Neurologi Authors describe
19856 ctive and divers oxygen oxygen cal improvement in cases
case in with treatme decompre where oxygen was
series hospit DCI nt ssion administered immediately
al (N= 70) illness for decompression
and air and sickness or air embolism.
embolis cerebral
m air
(N=39) aneurysm

Shinnick Literature Pre- Divers 100% No Preventio Review focuses on delay

19947 review and with oxygen oxygen n of in the initiation of
in compre as first treatme "permane treatment for diving
hospit ssed aid, nt nt emergencies and calls for
al gas hyperba disability emergency physicians to
(probab ric or even contact Divers Alert
ly oxygen death" Network (DAN). Authors
recreati in also emphasize the
onal) hospital importance of the
administration of 100%
oxygen.
Spira Literature EMS Divers 100% Not Preventio Advises 100% oxygen
19998 Review and with oxygen specifie n of during transport to a
in barotra during d sequelae facility where hyperbaric
hospit uma transfer of diving oxygen can be
al include to unit injuries administered.
air with
embolis hyperba
m and ric
DCI oxygen

Lippman Proceedi Preho Divers 100% Not Relief of Authors emphasize the
n 20039 ngs of spital with oxygen specifie symptoms importance of having
conferen DCI d , post oxygen equipment that
ce treatment can provide high oxygen
residua concentrations to
responsive or
unresponsive victims of
diving emergencies.
Longphr Retrospe Preho Divers "First aid No first Resolutio Authors noted that
e 200710 ctive spital using oxygen" aid n of oxygen decreased the

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 2024 ILCOR CoSTR Summary

cohort, compre prehospi supple symptoms number of recompression

2,231 ssed tal mentar and treatments needed if
individual gas y number of administered within 4
s oxygen retreatme hours of surfacing.
(N = nt
2231) recompre
ssion
Liow Retrospe Hospi Divers Hyperba None Neurologi Recommends 100%
200911 ctive tal with ric cal normobaric oxygen until
case and DCI oxygen recovery recompression therapy.
series preho (N = 3) (HBO)
spital and
normob
aric
100%
oxygen

Moon Literature Pre Recreat First aid Not Resolutio Recommends oxygen
2009 review and ional oxygen specifie n of administration within 4
8112 in divers prehospi d symptoms hours of injury based on
hospit with tal, and need Longphre study10
al DCI multiple for more findings.
other in- than one
hospital recompre
intervent ssion
ions treatment

Vann Literature Pre- Divers 100% Not Recovery Recommends the

201113 review and using oxygen specifie from administration of 100%
published in compre in d diving oxygen(O2) for several
in hospit ssed prehospi injury, hours, even after
seminar al gas tal symptom symptom resolution.
proceedi setting resolution
ngs
Blake Laborator Labor Healthy Oxygen NRB Transcuta Tissue oxygen partial
202014 y atory volunte breathe with neous pressure and
er d from oxygen measure nasopharyngeal inspired
divers 1) at 15 or ment of oxygen concentrations
(N = demand 10 tissue similar with demand valve
12) valve L/min oxygen with intraoral mask,
with partial medical O2 rebreathing
intraoral pressure system with oronasal or
mask in limbs intraoral mask, and NRB
and with flow rate 15 L/min.
nose Values lower for NRB at
clip or 2) flow rate 10 L/min.
medical
oxygen
rebreath
ing

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 2024 ILCOR CoSTR Summary

system
with
oronasal
mask
and with
intraoral
mask
Pollock. Literature Pre- Recreat High Not Not Concludes that high
201715 Review and ional partial specifie specified partial pressure oxygen is
in divers ( pressure d the primary first aid
hospit compre oxygen measure for DCI, can use
al ssed continuous flow with NRB
gases or pocket mask in diving
includin environment, but higher
g air, oxygen fraction can be
nitroge achieved in
n and spontaneously breathing
helium patients with mask and
mixture demand valve and
s rebreather systems.

Whayne Literature Pre- Comme 100% Not "Decreas Authors recommends

201816 Review and rcial oxygen specifie e immediate administration
in and in d complicati of 100% oxygen and
hospit recreati prehospi ons and rehydration with
al onal tal save intravenous isotonic fluids
divers setting lives" until hyperbaric oxygen
using therapy is available.
compre
ssed
gases

Abbreviations:
EMS Emergency Medical Service
NRB Non-rebreather mask
DCI Decompression Illness

Table S4. Chronic Obstructive Pulmonary Disease

Author; Study Setti Popula Interven Compa Outcomes Results/Key findings

Year Type ng tion tion rison
Publishe
d
Austin Systemat Pre Acute High “Contro Mortality Only 2 RCTs were
200617 ic review hospit exacer flow lled” from identified and were
of al bation oxygen. oxygen respiratory ongoing with no results
randomiz of Not causes published at the time of
ed Chronic defined Secondary the review.
controlled obstruc except outcomes
trials tive subgrou 1. All
(RCTs) pulmon p of flow cause

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 2024 ILCOR CoSTR Summary

ary for mortality

disease nebulize 2. Dyspnea
(AECO d score
PD) broncho 3. Arterial
dilators blood gas
– (ABG)
“typically 4. Length
6- of stay
8L/min” (LOS)
5. ICU
admission
6. Mental
status
score
7.
Conscious
ness score
(i.e., GCS)
8. Invasive
ventilation
9.
Noninvasiv
e
ventilation
10.Lung
function
11.Illness
score
Austin Cluster Preho COPD, Oxygen High Mortality, Titrated oxygen
201018 randomiz spital includin titrated concent respiratory treatment significantly
ed trial g to ration acidosis, reduced mortality,
AECOP saturatio oxygen: hypercapni hypercapnia, and
D ns of 88- High a, respiratory acidosis
(N = 92%; flow compared with high flow
405) nebulize oxygen oxygen in acute
d treatme exacerbations of chronic
broncho nt (8– obstructive pulmonary
dilators 10 disease.
delivere L/min)
d with adminis
compres tered
sed air. via a
(N=179) non-
rebreat
her
face
mask
and
bronch
odilator
s

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 2024 ILCOR CoSTR Summary

delivere
d by
nebuliz
ation
with
oxygen
flows of
6–8
l/min.

(N=
226)
Ntoumen Review Preho AECOP Titrated High Pre- and Synopsis of Austin
opoulos with spital D oxygen flow in-hospital 201018 study with
2011 Comment by NC to oxygen mortality; commentary and review
7000819 ary sat (8-10 length of of risk of hypercarbia
88%- L/min) stay, with high concentration
92% via ABGs. oxygen therapy, current
NRM guidelines for oxygen
delivery with AECOPD.
Wijesingh Retrospe Preho AECOP Oxygen Oxygen Death, When oxygen delivery
e 201120 ctive spital D administ adminis required was analyzed as a
observati patients ration at tration assisted continuous variable
onal transpo >/= 3 at <3 ventilation, according to
rted by L/min L/min respiratory documented flow rate,
ambula (N=168/ (define failure Increased oxygen flow
nce 92%), d as was associated with
(N = >/=8 low increased risk of death,
250) L/min, flow) assisted ventilation or
defined respiratory failure with
as high an odds ratio (OR) of
flow, via 1.2 (95% CI 1.0–1.4)
NC, per 1 L/min oxygen flow.
mask or Increasing PaO2 was
NRM associated with a
(N=90; greater risk of a poor
49%) outcome with an OR of
1.1 (95% CI 1.0–1.3)
per 10 mmHg higher
PaO2. A nonsignificant
association was
reported for the
dichotomous “high flow”
vs. “low flow” oxygen for
the main outcome
composite of death,
positive pressure
ventilation or respiratory
failure.

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 2024 ILCOR CoSTR Summary

Cameron Retrospe Preho AECOP Oxygen Oxygen Composite Adverse clinical

201221 ctive spital D saturatio saturati measure of outcomes were
observati patients n on on on hypercapni associated with both
onal transpo ABG ABG c hypoxemia (OR 2.16,
rted by within 4 within 4 respiratory 95% CI 1.11 to 4.20)
ambula hours of hours failure, and hyperoxemia (OR
nce arrival in of assisted 9.17, 95% CI, 4.08-
who ED arrival ventilation 20.6) compared with
had <88% or in ED or inpatient normoxemia (OR 2.16,
ABG >96% 88-92% death 95% CI, 1.11 - 4.20).
within 4 Results support titrating
hours oxygen to target oxygen
of saturation.
triage
(N=254
)
Pilcher Literature Pre- AECOP Titrated High Mortality Authors describe
201522 Review and D oxygen concent evidence from Austin18
in and air- ration of mortality risk if
hospit driven or high patients with AECOPD
al nebuliza dose received high
tion of oxygen concentration oxygen,
broncho guidelines for use of
dilators oxygen only if SpO2
<88%, titration-to 88-
92%, use of air-driven
delivery of nebulized
bronchodilators.

Ringbaek Observati Pre- AECOP Oxygen, Oxygen Respiratory Review aimed to assess
201523 onal and D varying , acidosis at the frequency of
study in- patients flow varying hospital “inappropriate oxygen
hospit transpo rates flow admission, therapy” (determined by
al rted by rates length of an oxygen saturation of
ambula stay, 92% or greater) given in
nce ventilatory ambulance for AECOPD
who support, in- patients. A total of 352
receive hospital (88.7%) of 397 patients
d any mortality were deemed to have
oxygen received inappropriate
oxygen therapy based
(N=405 on an O2 saturation of
) 92% or greater. Of this
group of patients, 33.5%
had respiratory acidosis
at hospital admission.
Lumholdt Retrospe Preho Patient CO2 No CO2 Hypercapa 11 patients with
201724 ctive spital s retention retentio nic respiratory conditions
observati brought n acidosis brought to ED by EMS
onal; to due to and found to have CO2
Abstract Emerge excessive retention and acidosis.

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 2024 ILCOR CoSTR Summary

ncy prehospital The mean oxygen

Depart oxygen saturation of the 11
ment patients with CO2
(ED) retention was 84% on
with presentation to EMS
“respira and 95% on arrival in
tory ED. They inferred this
conditio was due to excessive
ns” oxygen administration
EMS before arrival in
care hospital.
only
provide
d with
100%
oxygen.
(N=125
)
Bentsen Retrospe Pre- COPD High Titrated 30-day 30-day mortality of 56
202025 ctive hospit transpo flow oxygen mortality patients with AECOPD
observati al rted to Oxygen treated with high-flow
onal hospital oxygen was 11.5% vs
by 9.4% in the titrated
Emerge oxygen group (P=0.41).
ncy A change of treatment
Medical protocols to titrated
Service oxygen was associated
s with a lower 30-day
(EMS) mortality for patients
before with an acute
and exacerbation of COPD,
after but not for all COPD
implem patients.
nting a
change
in
prehos
pital
oxygen
protoco
led
from
high
flow to
titrated
oxygen.
N=707
Kopsaftis Cochrane Pre- Adults "Controll "Stand "Mortality" The one included study
202026 review hospit with ed ard (Austin)18 found a
al acute oxygen" oxygen reduction in pre/in-
EMS exacer " cited hospital mortality for the

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 2024 ILCOR CoSTR Summary

bation in the titrated oxygen arm

of single compared to the high-
COPD paper flow control arm.
as: However, the paucity of
High evidence limits the
concent reliability of these
ration findings and
oxygen: generalizability to other
High settings.
flow
oxygen
treatme
nt (8–
10
L/min)
adminis
tered
via a
non-
rebreat
her
face
mask
and
bronch
odilator
s
delivere
d by
nebuliz
ation
with
oxygen
flows of
6–8
l/min.
Hodroge Evidence Preho Adult Titrated High Mortality Concluded that titration
202027 Based spital patients Oxygen Flow of oxygen to 94-96% for
Guideline with oxygen most patients and 88-
respirat (not 92% for those with
ory defined AECOPD was
distress ) associated with lower
mortality.
Barnett Evidence Pre- COPD N/A N/A N/A Key recommendations:
202228 based and assess oxygenation,
guideline in oxygen requires
hospit prescription and to set
al oxygen saturation
targets of 88-92% for
individuals with potential

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 2024 ILCOR CoSTR Summary

hypercapnia and 92-

96% for others.
Gottlieb Evidence Preho All titrated High Mortality Recommends the use of
202229 based spital patients oxygen flow and pulse oximetry to
guideline. conside oxygen “functional assess the need for
red for outcome" oxygen before
supple administering it, except
mentar for in critical situations
y (e.g. during CPR).
oxygen

Jensen Randomi Preho AECOP Titrated Standar 30-day Protocol for RCT
202330 zed spital, D oxygen d high mortality comparing targeted
control gas and flow prehospital oxygen
trial study used compres oxygen therapy with standard
protocol to sed air high concentration/flow
drive driven oxygen.
inhale inhaled
d broncho
bronc dilators
hodila to target
tors SpO2
(oxygen
(Plan saturatio
ned n) 88-
N=1,8 92%
88)
Gude Randomi Preho AECOP Titrated Standar 30-day N/A not completed
NCT0570 zed spital, D oxygen d high mortality
391931 control gas and flow
trial used compres oxygen
registere to sed air
d in USA. drive driven
(Same inhale inhaled
trial as d broncho
Jensen bronc dilators
2023 hodila to target
published tors SpO2
study (oxygen
protocol.) saturatio
n) 88-
92%
Abbreviations Table 1-3:
ABG, arterial blood gas; AECOPD, acute exacerbation of COPD; CI, confidance interval; CO2,
carbon dioxide; COPD, chronic obstructive pulmonary disease; CPR; cardiopulmonary
resuscitation; ED, emergency department; EMS, emergency medical services; GCS, Glasgow
coma scale; HR, hazard ratio; ICU, intensive care unit; L/min, liters per minute; LOS, length of
stay; N/A, not applicable; NC,nasal cannula; NRM, nonrebreather face mask; OR, odds ratio;
RCT, randomized controlled trial; RR, relative risk

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2024 ILCOR CoSTR Summary

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