Guidelines Process

Sue Hampshire
Andrew Lockey
Jonathan Wyllie
Suzanne Horner
Published May 2021.
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  • The International Liaison Committee on Resuscitation (ILCOR, includes representation from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), the Resuscitation Councils of Southern Africa (RCSA), the Inter-American Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). ILCOR is responsible for the production of the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), which is subsequently used by member organisations to develop guidelines.
  • From 2000 to 2015, representatives from the ILCOR member councils evaluated the resuscitation science in 5-yearly cycles. After publication of the 2015 CoSTR, ILCOR committed to a continuous evidence-evaluation process, with topics prioritised for review by the task forces and with CoSTR updates published annually. All ILCOR CoSTR updates were open for public comment before final publication on the website.
  • For the 2020 CoSTR, the ILCOR task forces undertook three types of evidence evaluation: systematic reviews, scoping reviews, and evidence updates, which covered 184 topics in total. It was agreed that only systematic reviews, which used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, could result in new or modified ILCOR treatment recommendations. The data analysis from each systematic review was presented to the task force, and the task force drafted the summary CoSTR. Each treatment recommendation indicated the strength of the recommendation (recommends=strong, suggests=weak) and the certainty of the evidence.
  • Draft 2020 CoSTRs were posted on the ILCOR website ( for a two-week public consultation period after which final wording of science statements and treatment recommendations were completed by the task forces. These were published in Resuscitation and Circulation as the 2020 CoSTR.

The European Resuscitation Council (ERC) guidelines process

  • The ERC guidelines are based on the ILCOR 2020 CoSTR.
  • For the ERC Guidelines, the ILCOR recommendations were supplemented by focused literature reviews undertaken by the ERC Writing Groups for those topics not reviewed in the 2020 ILCOR CoSTR.
  • When required, the guidelines were informed by the expert consensus of the writing group’s membership.
  • The ERC guidelines were drafted and agreed by the Writing Group members before posting for a two-week public consultation period. Post consultation and review, revised guidelines were approved for publication by the ERC General Assembly in December 2020.

Resuscitation Council UK (RCUK) guidelines process

  • The RCUK guidelines are distilled from the ERC guidelines and where necessary supplemented by focused literature reviews. The RCUK Guidelines Working Group was established to review each section to ensure relevance to UK practice. Each section was reviewed by a working group including RCUK experts as well as representation from other professional and public organisations. No further public consultation was carried out as there was no material change and the guidelines had already been subjected to public scrutiny as part of the ILCOR and ERC process. Guidelines were reviewed for adherence to current UK practice and to include specific UK systems. RCUK completed an impact assessment review on final documents.
  • The process used to produce the Resuscitation Council UK Guidelines 2021 is accredited by the National Institute for Health and Care Excellence (NICE).  The guidelines process includes: 
    • Systematic reviews with grading of the quality of evidence and strength of recommendations. This led to the 2015 International Liaison Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. 
    • The involvement of stakeholders from around the world including members of the public and cardiac arrest survivors. 
    • Details of the guidelines development process can be found in the Resuscitation Council UK Guidelines Development Process Manual.

RCUK is committed to promoting equality, eliminating unlawful discrimination and actively considering the implications of its guidance for human rights. It aims to comply fully with the Equality Act (2010). 

Download RCUK's completed Equality Impact Assessment for the 2021 Guidelines

ERC Guidelines 2021:

Developing NICE Guidelines: the manual