An appraisal of the Australian Resuscitation Council arrhythmia guideline

Pieter F Fouche, Kristina Zverinova

Abstract


Introduction

Arrhythmias are a significant health burden in Australia, responsible for about 1% of deaths annually. The Australian Resuscitation Council (ARC) ‘Guideline 11.9 Managing Acute Dysrhythmias’ was designed to guide doctors, paramedics and nurses in the emergency management of arrhythmias. It is important to have high quality clinical practice guidelines to aid the treatment of these arrhythmias. The AGREE II tool utilised is widely used to asses clinical practice guidelines for quality. The objective of this study was to assess the quality of the ARC clinical practice guideline ‘Guideline 11.9 Managing Acute Dysrhythmias’.

Methods

Two raters assessed the six domains of quality of the ARC arrhythmia guideline using the AGREE II tool. The inter-rater agreement between the raters was measured with the intraclass correlation coefficient (ICC 2, 1).

Results

Inter-rater agreement was good at 0.73 (95% CI 0.45 to 0.88). Both raters assigned the ARC guideline 11.9 Managing Acute Dysrhythmias a score of three, for a combined score of three out of a possible seven on the AGREE II rating scale.

Conclusions

The use of the ARC guideline 11.9 Managing Acute Dysrhythmias is not recommended based on this assessment with the AGREE II tool. Emergency departments and prehospital systems should consider not using this arrhythmia guideline to guide their practice, but to look elsewhere for a higher quality guideline.


Keywords


arrhythmia; dysrhythmia; guideline; prehospital; Australian Resuscitation Council

Full Text:

PDF

References


Australian Resuscitation Council - Guideline 1.1 Aims and Objectives of the Australian Resuscitation Council, 2003. Available at: www.resus.org.au/policy/guidelines/section_1/aims_and_objectives.htm [Accessed 10 October 2013].

Australian Resuscitation Council. Guideline 1.4 Principles and Format for Developing Guidelines, 2010. Available at: www.resus.org.au/ [Accessed 10 November 2014].

Australian Resuscitation Council. Guideline 11.9 Managing Acute Dysrythmias, November 2009. Available at: www.resus.org.au/policy/guidelines/section_11/managing_acute_dysrhythmias.htm [Accessed 8 August 2012].

Wesley K. Huszar's Basic Dysrhytmias and AcutCoronary Syndromes: Interpretation and Management. 4th edn. Missouri, Elsevier, 2011.

Australian Bureau of Statistics, 2002. Causes of Death, Australia, 2001, cat. no. 3303.0. Available at: www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/B6855924C11B28B7CA256C8A007F3F4E/$File/33030_2001.pdf [Accessed 30 December 2013].

Australian Bureau of Statistics, 2013. Causes of Death, Australia, 2011, cat. no. 3303.0. Available at: www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/74DFAC9DA1E27ADACA257B2E000D74C5?opendocument [Accessed 30 December 2013].

Australian Bureau of Statistics, 2013. Causes of Death, Australia, 2010, cat. no. 3303.0. Available at: www.abs.gov.au/ausstats/abs@.nsf/Products/6BAD463E482C6970CA2579C6000F6AF7?opendocument [Accessed 30 December 2013].

Australian Bureau of Statistics, 2013. Causes of Death, Australia, 2011, cat. no. 3303.0. Available at: www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Chapter42011 [Accessed 30 December 2013].

Australian Institute of health and Welfare, 2013. Treatment for cardiovascular disease. Available at: www.aihw.gov.au/cardiovascular-health/treatment/ [Accessed 29 December 2013].

Ebben RH, Vloet LC, Verhofstad MH, Meijer S, Mintjes-de Groot JA, van Achterberg T. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review. Scand J Trauma Resusc Emerg Med 2013;21:9.

Burls A. AGREE II - improving the quality of clinical care. Lancet 2010;376:1128–9.

National Institute of Clinical Studies, 2006. Do guidelines make difference health care outcomes? Available at: www.nhmrc.gov.au/_files_nhmrc/file/nics/material_resources/Do%20guidelines%20make%20a%20difference%20to%20health%20care%20outcomes.pdf [Accessed 24 March 2014].

AGREE Next Steps Consortium. The AGREE II Instrument 2009 Available at: www.agreetrust.org [Accessed 7 September 2013].

AGREE Next Steps Consortium. AGREE related publications. Available at:

www.agreetrust.org/resource-centre/agree-related-publications/ [Accessed 7 January 2014].

Morley PT, Atkins DL, Billi JE, et al. Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2010;81(Suppl 1):e32–40.

Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86(2):420–8.

Cochrane LJ, Olson CA, Murray S, Dupuis M, Tooman T, Hayes S. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. J Contin Educ Health Prof 2007;27(2):94–102.

Simpson F, Doig GS. The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines. Journal of Evaluation in Clinical Interventions 2007;13(5):709–15.

Baker R, Camosso-Stefinovic J, Gillies C, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD005470. DOI: 10.1002/14651858.CD005470.pub2 [cited 2014 26 March]; Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005470.pub2/pdf

Feder G, Eccles M, Grol R, Griffiths C, Grimshaw J. Using clinical guidelines BMJ 1999;318:728

Scott IA, Guyatt GH. Clinical practice guidelines: the need for greater transparency in formulating recommendations. Med J Aust 2011;195(1):29–33.

Australian Resuscitation Council - Home 2013. Available at: www.resus.org.au/Default.htm. [Accessed 10 October 2013].

Australian Resuscitation Council, ARC Representatives 2013. Available at: www.resus.org.au/council.html [Accessed 10 October 2013].

McAnulty JA. Arrhythmias in Pregnancy. Cardiol Clin 2012;30:425–34.

Vitry AI, Zhang Y. Quality of Australian clinical guidelines and relevance to the care of older people with multiple comorbid conditions. Med J Aust 2008;189:360–5.

Morley PT, Atkins DL, Billi JE, et al. Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010;122(16 Suppl 2):S283–90.

International Liaison Committee on Resuscitation - About Ilcor. 2013 Available at: www.ilcor.org/about-ilcor/about-ilcor/ [Accessed 11 November 2013].

Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S640–56.

Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 2001;286(12):1461–7.

Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2010;81:1293–304.




DOI: http://dx.doi.org/10.33151/ajp.11.6.127

Refbacks

  • There are currently no refbacks.




The Official Journal of Paramedics Australasia © 2019                           ISSN: 2202-7270

 

Crossref Member Badge