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Practice Editing Here (Nov 15th in-class Wiki session work)
Cardiac Arrest

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!
Proposed Changes to ‘Medications Management’

First paragraph: Based on 2019 guidelines,1mg of epinephrine may be administered to patients every 3-5 minutes, but high dose epinephrine is not recommended for routine use in cardiac arrest. If the patient has a non-shockable rhythm, the epinephrine should be administered as soon as possible. For a shockable rhythm, epinephrine should only be administered after initial defibrillation attempts have failed.

Proposed Changes to ‘Target Temperature Management’

First two sentences changed: Current international guidelines suggest cooling adults after cardiac arrest using targeted temperature management (TTM), which was previously known as therapeutic hypothermia.

Second paragraph, first sentence changed: Effectiveness of TTM after out-of-hospital cardiac arrest is an area of ongoing study.

Second paragraph (directly after sentence change proposed above): A 2018 systematic review and meta-analysis suggests that TTM in post-arrest care does not improve mortality or neurological outcomes. Moreover, TTM may have adverse neurological effects in people who survive post cardiac arrest. Another recent meta-analysis suggests pre-hospital TTM after out-of-hospital cardiac arrest may increase risk of adverse outcomes, with rates of re-arrest higher in cases of pre-hospital TTM. These recent studies suggest more research is needed surrounding TTM.

Kalra R, Arora G, Patel N, Doshi R, Berra L, Arora P, Bajaj NS. Targeted Temperature Management After Cardiac Arrest: Systematic Review and Meta-analyses. Anesth Analg. 2018 Mar;126(3):867-875. doi: 10.1213/ANE.0000000000002646. PMID: 29239942; PMCID: PMC5820193.

Lindsay PJ, Buell D, Scales DC. The efficacy and safety of pre-hospital cooling after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Crit Care. 2018 Mar 13;22(1):66. doi: 10.1186/s13054-018-1984-2. PMID: 29534742; PMCID: PMC5850970.

Panchal, Ashish R.; Berg, Katherine M.; Hirsch, Karen G.; Kudenchuk, Peter J.; Del Rios, Marina; Cabañas, José G.; Link, Mark S.; Kurz, Michael C.; Chan, Paul S.; Morley, Peter T.; Hazinski, Mary Fran (2019-12-10). "2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 140 (24): e881–e894. doi:10.1161/CIR.0000000000000732

Rationale:

The first paragraph in the ‘Medications Management’ section discusses the use of epinephrine during management of cardiac arrest. This information is based on the American Heart Association 2015 clinical guidelines, which have since been updated in 2018. The proposed change for this section will elaborate on the use of epinephrine in cardiac arrest including dosage, timing, and administering with shockable and non-shockable rhythms. This will provide clarification surrounding epinephrine use and cite the most recent literature available for clinical guidelines.

The first replacement sentence to the second paragraph of the ‘Target Temperature Management’ (TTM) section encompasses and clarifies the original content of the Wiki article to ensure readers understand the current international guidelines (although the guidelines are from less recent sources). However, since they are international guidelines, it is important to recognize that they still exist and explain what TTM is (using information from the original Wiki article). The sentence of the second paragraph in the ‘Targeted Temperature Management’ section that states that recent studies found TTM after out-of-hospital cardiac arrest is associated with improved survival rates and better neurological outcomes. This study was from 2016, and more recently contending studies have shown that the effectiveness of TTM is up for debate. As a result, the proposed change better encompasses more recent scientific discussion regarding the use of TTM.

The new additional sentences in this section use evidence from more recent meta-analyses to correct the current Wiki information by stating that there is evidence against better neurological outcomes and survival rates, contrary to what the original article states. Furthermore, the addition also clarifies new studies showing that there may be adverse effects with this treatment, which was not acknowledged in the original text.

Areas of Controversy:

One of the difficult parts of editing this part of the article is that the use of TTM has long been debated. However, it is unclear if TTM is beneficial or if simply avoiding hyperthermia is always the objective with cardiac arrest (pre- or post-hospitalization). Given the recency, rigor, and evidence-based research of the two different articles used as the foundations for our edits, it seemed important to provide a holistic overview of TTM and its potential benefits while also including the potential for adverse effects. For transparency, it was also important to recognize that more research still needs to be done due to these areas of controversy.

Critique of Sources:

For the medication management changes, the updated clinical guidelines for cardiovascular life support from the American Heart Association are used as reference. This is a leading resource for information related to cardiovascular resuscitation and cardiac support in the clinical setting. After assessing the working group and authors for any conflict of interest or source of bias, we concluded that this information is credible.

Both citations used in the TTM section are systematic reviews and meta-analyses, which present high quality of evidence. In the first citation (by Kalra et al.) sources of bias like publication bias were clearly discussed and accounted for using funnel plots as outlines and Egger’s regression intercept. It states that the authors have no conflicts of interest, and the footnotes section clearly outlines how each author individually contributed. The second source (by Lindsay et al.) also states no conflicts of interest, ethical considerations, and states that the publisher, Springer Nature, remains neutral. Thus, we considered these sources reliable and effective when writing our proposed changes.

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template